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Revision as of 17:32, 11 December 2007 editMattisse (talk | contribs)78,542 edits returning POV tag which was removed without addressing issues on talk page - inaccurate references continue to be restored - the article mixes up UK and US practices & does not distinguish between res← Previous edit Latest revision as of 04:19, 14 December 2024 edit undo2603:6010:ce00:2c58:39f4:3597:dd8f:31ff (talk) Used the word appeared and apparent in one sentence. I changed it to feigned as it was redundant.Tags: Mobile edit Mobile web edit 
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{{Short description|Mental health disorder}}
{{POV}}
{{distinguish|Psychosis|Psychopathology|Psychic|Sycophancy}}
{{DiseaseDisorder infobox |
{{redirect2|Psychopaths|Psychopath|other uses|Psychopath (disambiguation)}}
Name = Dissocial personality disorder |
{{redirect2|Sociopathy|Sociopath|another usage of these terms|antisocial personality disorder}}
ICD10 = F60.2 |
{{cs1 config|name-list-style=vanc}}
ICD9 = {{ICD9|301.7}} |
}} {{pp-pc}}
{{Infobox medical condition (new)
'''Psychopathy''' (also known as '''Sociopathy''') is defined in ] and ] as a condition characterized by lack of ]<ref>{{cite journal |author=de Wied M, Goudena PP, Matthys W |title=Empathy in boys with disruptive behavior disorders |journal=Journal of child psychology and psychiatry, and allied disciplines |volume=46 |issue=8 |pages=867-80 |year=2005 |pmid=16033635 |doi=10.1111/j.1469-7610.2004.00389.x}}</ref><ref>{{cite journal |author=Fernandez YM, Marshall WL |title=Victim empathy, social self-esteem, and psychopathy in rapists |journal=Sexual abuse : a journal of research and treatment |volume=15 |issue=1 |pages=11-26 |year=2003 |pmid=12616926 |doi=10.1023/A:1020611606754}}</ref> ], and poor ]<ref>{{cite journal |author=Johansson P, Kerr M, Andershed H |title=Linking adult psychopathy with childhood hyperactivity-impulsivity-attention problems and conduct problems through retrospective self-reports |journal=J. Personal. Disord. |volume=19 |issue=1 |pages=94-101 |year=2005 |pmid=15899723 |doi=10.1521/pedi.19.1.94.62183}}</ref><ref>{{cite journal |author=Lesch KP, Merschdorf U |title=Impulsivity, aggression, and serotonin: a molecular psychobiological perspective |journal=Behavioral sciences & the law |volume=18 |issue=5 |pages=581-604 |year=2000 |pmid=11113963 |doilabel=10.1002/1099-0798(200010)18:5<581::AID-BSL411>3.0.CO;2-L |doi=10.1002/1099-0798(200010)18:5%3C581::AID-BSL411%3E3.0.CO;2-L}}</ref> or manipulative behaviors.<ref>Babiak, P. Psychopathic manipulation in organizations: Pawns, patrons, and patsies. In D. J. Cooke, A. E. Forth, J. P. Newman, & R. D. Hare (Eds.), Issues in ] and ]: No. 24, International perspective on psychopathy (pp. 12-17). Leicester, UK: British Psychological Society 1996</ref> It is a term derived from the ] ] (''soul, breath hence mind'') and ] (''to suffer''), and was once used to denote any form of ], often being confused with ]. The term is often used interchangeably with ''sociopathy'',<ref> e.g. Arthur S. Reber. ''Penguin Dictionary of Psychology''. 2nd. ed. Harmondsworth, UK: Penguin, 1995</ref> but there are differences among the three.
| name = Psychopathy
| pronounce = {{IPAc-en|s|aɪ|ˈ|k|ɒ|p|ə|θ|i}}
| field = ], ], ]
| symptoms = ], ], ], lack of ] or ], inclination to ] and ], ], ]
| complications =
| onset =
| duration =
| types =
| causes = Genetic factors, low drive for affiliation, experiencing neglect or maltreatment
| risks = ], fearless temperament, experiencing neglect or maltreatment
| diagnosis =
| differential = ], ], ], ], other psychotic disorders such as ], ], ]
| prevention = Proper care of children
| treatment = Forms of ] including ] for adults and parent management training for children
| medication = None
| prognosis = Poor
| frequency =
| deaths =
}}'''Psychopathy''', or '''psychopathic personality''',<ref>{{Cite web |title=Psychopathic Personality and How It Develops {{!}} HealthyPlace |url=https://www.healthyplace.com/personality-disorders/psychopath/psychopathic-personality-and-how-it-develops |access-date=2024-04-11 |website=www.healthyplace.com}}</ref> is a ] ]<ref>{{Cite web |last=Blackburn |first=Ronald |date=2005 |title=Psychopathy as a Personality Construct. |url=https://psycnet.apa.org/record/2005-04993-015 |url-status=live |archive-url=https://web.archive.org/web/20230905192012/https://psycnet.apa.org/record/2005-04993-015 |archive-date=5 September 2023 |access-date=12 June 2024 |website=American Psychiatric Association}}</ref><ref>{{Cite journal |last1=Driessen |first1=Josi M. A. |last2=van Baar |first2=Jeroen M. |last3=Sanfey |first3=Alan G. |last4=Glennon |first4=Jeffrey C. |last5=Brazil |first5=Inti A. |date=July 2021 |title=Moral strategies and psychopathic traits |url=https://pubmed.ncbi.nlm.nih.gov/34472890/ |journal=Journal of Abnormal Psychology |volume=130 |issue=5 |pages=550–561 |doi=10.1037/abn0000675 |issn=1939-1846 |pmid=34472890|hdl=2066/236779 |hdl-access=free }}</ref> characterized by impaired ] and ], in combination with ] of ], ], and ]. These traits are often masked by ] and ],<ref>{{Cite journal |last1=Schönthaler |first1=Elena M. D. |last2=Dalkner |first2=Nina |last3=Schwalsberger |first3=Karin |last4=Reininghaus |first4=Eva Z. |last5=Reininghaus |first5=Bernd |date=2023-03-27 |title=Psychopathic personality traits stress immunity and social potency moderate the relationship between emotional competence and cognitive functions in depression |journal=Frontiers in Psychiatry |volume=14 |pages=1061642 |doi=10.3389/fpsyt.2023.1061642 |doi-access=free |issn=1664-0640 |pmid=37051168|pmc=10084668 }}</ref> which create an outward appearance of feigned normalcy.<ref name="triarchic model" /><ref name="Without Conscience" /><ref name=":19">{{cite book |last1=Stone |first1=Michael H. |title=The New Evil: Understanding the Emergence of Modern Violent Crime |last2=Brucato |first2=Gary |date=2019 |publisher=] |isbn=978-1-63388-532-5 |location=Amherst, New York |pages=48–52}}</ref><ref>{{Cite journal |last1=Smith |first1=Sarah Francis |last2=Lilienfeld |first2=Scott O. |last3=Coffey |first3=Karly |last4=Dabbs |first4=James M. |date=October 2013 |title=Are psychopaths and heroes twigs off the same branch? Evidence from college, community, and presidential samples |url=https://doi.org/10.1016/j.jrp.2013.05.006 |journal=Journal of Research in Personality |volume=47 |issue=5 |pages=634–646 |doi=10.1016/j.jrp.2013.05.006 |issn=0092-6566}}</ref><ref>{{Cite journal |last1=Anderson |first1=Jaime L. |last2=Sellbom |first2=Martin |last3=Wygant |first3=Dustin B. |last4=Salekin |first4=Randall T. |last5=Krueger |first5=Robert F. |date=October 2014 |title=Examining the associations between DSM-5 section III antisocial personality disorder traits and psychopathy in community and university samples |url=https://pubmed.ncbi.nlm.nih.gov/24689766/ |journal=Journal of Personality Disorders |volume=28 |issue=5 |pages=675–697 |doi=10.1521/pedi_2014_28_134 |issn=1943-2763 |pmid=24689766}}</ref>

], an American ], influenced the initial diagnostic criteria for antisocial personality reaction/disturbance in the '']'' (DSM), as did American psychologist ].<ref name="Partridge1930">{{cite journal |first=George E. |last=Partridge |author-link=George E. Partridge |title=Current Conceptions of Psychopathic Personality |journal=] |publisher=] |location=Philadelphia, Pennsylvania |volume=1 |issue=87 |date=July 1930 |pages=53–99 |doi=10.1176/ajp.87.1.53|issn = 0002-953X}}</ref> The ''DSM'' and '']'' (ICD) subsequently introduced the diagnoses of ] (ASPD) and dissocial personality disorder (DPD) respectively, stating that these diagnoses have been referred to (or include what is referred to) as psychopathy or ]. The creation of ASPD and DPD was driven by the fact that many of the classic traits of psychopathy were impossible to measure objectively.<ref name="gap" /><ref name="Semple">{{cite book |first=David |last=Semple |year=2005 |title=The Oxford Handbook of Psychiatry |publisher=] |location=Oxford, England |pages=448–9 |isbn=978-0-19-852783-1}}</ref><ref name="Handbook of Psychopathy" /><ref name="Hare1996">{{cite journal |first=Robert D. |last=Hare |author-link=Robert D. Hare |url=http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831 |title=Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion |journal=] |publisher=MJH Associates |location=New York City |volume=13 |issue=2 |date=February 1, 1996 |url-status=live |archive-url=https://web.archive.org/web/20130528053223/http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831 |archive-date=May 28, 2013}}</ref><ref name="HareHarpur">{{cite journal |doi=10.1037/0021-843X.100.3.391 |title=Psychopathy and the ''DSM-IV'' criteria for antisocial personality disorder |year=1991 |last1=Hare |first1=Robert D. |author-link1=Robert D. Hare |last2=Hart |first2=Stephen D. |last3=Harpur |first3=Timothy J. |journal=] |volume=100 |issue=3 |pages=391–8 |pmid=1918618 |url=https://philpapers.org/rec/HARPAT-27 |access-date=2018-10-02 |archive-date=2020-08-06 |archive-url=https://web.archive.org/web/20200806172317/https://philpapers.org/rec/HARPAT-27 |url-status=live}}</ref> Canadian psychologist ] later re-popularized the construct of psychopathy in criminology with his ].<ref name="gap" /><ref name="Handbook of Psychopathy" /><ref name="aspd statement">{{cite book |last=Andrade |first=Joel |date=23 Mar 2009 |title=Handbook of Violence Risk Assessment and Treatment: New Approaches for Mental Health Professionals |url=https://books.google.com/books?id=_zxz3XqE8MkC |location=New York City |publisher=] Company |isbn=978-0-8261-9904-1 |access-date=January 5, 2014 |archive-date=25 January 2021 |archive-url=https://web.archive.org/web/20210125181730/https://books.google.com/books?id=_zxz3XqE8MkC |url-status=live |via=]}}</ref><ref name="Hare Psychopathy Checklist">{{cite encyclopedia |url=http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html |title=Hare Psychopathy Checklist |encyclopedia=Encyclopedia of Mental Disorders |access-date=September 4, 2013 |url-status=live |archive-url=https://web.archive.org/web/20130904123901/http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html |archive-date=September 4, 2013}}</ref>

Although no ] or ] organization has sanctioned a diagnosis titled "psychopathy", assessments of psychopathic characteristics are widely used in ] settings in some nations and may have important consequences for individuals.{{Specify|date=October 2021|reason=What are those consequences? For which individuals?}} The study of psychopathy is an active field of research. The term is also used by the general public, popular press, and in ].<ref name="Hare Psychopathy Checklist" /><ref name="LecterMyth">{{cite journal |doi=10.1007/s10862-009-9147-z |title=The Hannibal Lecter Myth: Psychopathy and Verbal Intelligence in the MacArthur Violence Risk Assessment Study |year=2009 |last1=Delisi |first1=Matt |last2=Vaughn |first2=Michael G. |last3=Beaver |first3=Kevin M. |last4=Wright |first4=John Paul |journal=] |publisher=] |location=New York City |volume=32 |issue=2 |pages=169–77 |s2cid=16184054}}</ref> While the abbreviated term "psycho" is often employed in common usage in general media along with "crazy", "]", and "mentally ill", there is a categorical difference between ] and psychopathy.<ref>{{cite book |last=Hare |first=Robert D. |author-link=Robert D. Hare |title=Without Conscience: The Disturbing World of the Psychopaths Among Us |publisher=] |location=New York City |year=1999 |page= |isbn=978-1-57230-451-2 |url=https://archive.org/details/withoutconscienc00hare/page/22}}</ref>

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== Signs and symptoms ==
Socially, psychopathy typically involves extensive callous and manipulative self-serving behaviors with no regard for others and often is associated with repeated delinquency, crime, and violence. Mentally, impairments in processes related to ] and ], particularly socially related mental processes, have also been found. Developmentally, symptoms of psychopathy have been identified in young children with ] and suggest at least a partial constitutional factor that influences its development.<ref name=":0">{{Cite journal |last1=de Almeida |first1=Rosa Maria Martins |last2=Cabral |first2=João Carlos Centurion |last3=Narvaes |first3=Rodrigo |year=2015 |title=Behavioural, hormonal and neurobiological mechanisms of aggressive behaviour in human and nonhuman primates |journal=] |volume=143 |pages=121–135 |doi=10.1016/j.physbeh.2015.02.053 |pmid=25749197 |s2cid=27711931}}</ref>

=== Primary features ===
Disagreement exists over which features should be considered as part of psychopathy, with researchers identifying around 40 traits supposedly indicative of the construct,<ref name=":3" /><ref name=":4" /> though the following characteristics are almost universally considered central.

==== Core traits ====
Cooke and Michie (2001)<ref name=":5" /> proposed a three-factor model of the Psychopathy Checklist-Revised which has seen widespread application in other measures (e.g., Youth Psychopathic Traits Inventory,<ref name=":6" /> Antisocial Process Screening Device<ref name=":7" />).

* ''Arrogant and deceitful interpersonal style'': impression management or superficial charm, inflated and grandiose sense of self-worth, pathological lying/deceit, and manipulation for personal gain.
* ''Deficient affective experience'': lack of remorse or guilt, shallow affect (coldness and unemotionality), callousness and lack of empathy, and failure to accept responsibility for own actions.
* ''Impulsive and irresponsible lifestyle'': impulsivity, sensation-seeking and risk-taking, irresponsible and unreliable behavior, financially parasitic lifestyle, and a lack of realistic, long-term goals.

==== Low anxiety and fearlessness ====
Cleckley's (1941) original description of psychopathy included the absence of nervousness and neurotic disorders, and later theorists referred to psychopaths as fearless or thick-skinned.<ref name=":8" /> While it is often claimed that the PCL-R does not include low anxiety or fearlessness, such features do contribute to the scoring of the Facet 1 (interpersonal) items, mainly through self-assurance, unrealistic optimism, brazenness, and imperturbability.<ref name=":9" /> Indeed, while self-report studies have been inconsistent using the two-factor model of the PCL-R, studies which separate Factor 1 into interpersonal and affective facets, more regularly show modest associations between Facet 1 and low anxiety, boldness and fearless dominance (especially items assessing glibness/charm and grandiosity).<ref name=":10" /><ref name=":11" /><ref name=":12" /> When both psychopathy and low anxiety/boldness are measured using interviews, both interpersonal and affective facets are both associated with fearlessness and lack of internalizing disorders.<ref name=":13" /><ref name=":14" /><ref name=":15" />

The importance of low anxiety/fearlessness to psychopathy has historically been underscored through behavioral and physiological studies showing diminished responses to threatening stimuli (interpersonal and affective facets both contributing).<ref name=":16" /> However, it is not known whether this is reflected in the reduced experience of state fear or where it reflects impaired detection and response to threat-related stimuli.<ref name=":17" /> Moreover, such deficits in threat responding are known to be reduced or even abolished when attention is focused on the threatening stimuli.

=== Offending ===

==== Criminality ====
], violence, and antisocial behavior.]]
In terms of simple correlations, the PCL-R manual states an average score of 22.1 has been found in North American prisoner samples, and that 20.5% scored 30 or higher. An analysis of prisoner samples from outside North America found a somewhat lower average value of 17.5. Studies have found that psychopathy scores correlated with repeated imprisonment, detention in higher security, disciplinary infractions, and substance misuse.<ref name="Patrick2005a">{{cite book |title=Handbook of Psychopathy |date=2005 |publisher=] |isbn=978-1-59385-591-8 |editor1-last=Patrick |editor1-first=Christopher J |location=New York City |pages=440–3}}</ref><ref name="englandandwales2009">{{cite journal |last1=Coid |first1=Jeremy |last2=Yang |first2=Min |last3=Ullrich |first3=Simone |last4=Roberts |first4=Amanda |last5=Moran |first5=Paul |last6=Bebbington |first6=Paul |last7=Brugha |first7=Traolach |last8=Jenkins |first8=Rachel |last9=Farrell |first9=Michael |last10=Lewis |first10=Glyn |last11=Singleton |first11=Nicola |last12=Hare |first12=Robert |date=May 2009 |title=Psychopathy among prisoners in England and Wales |url=https://www.researchgate.net/publication/24256789 |url-status=live |journal=] |location=Amsterdam, Netherland |publisher=] |volume=32 |issue=3 |pages=134–41 |doi=10.1016/j.ijlp.2009.02.008 |pmid=19345418 |archive-url=https://web.archive.org/web/20160413022016/https://www.researchgate.net/publication/24256789_Psychopathy_among_prisoners_in_England_and_Wales |archive-date=13 April 2016 |access-date=1 April 2016}}</ref>

Psychopathy, as measured with the PCL-R in institutional settings, shows in ] small to moderate ]s with institutional misbehavior, postrelease crime, or postrelease violent crime with similar effects for the three outcomes. Individual studies give similar results for adult offenders, forensic psychiatric samples, community samples, and youth. The PCL-R is poorer at predicting sexual re-offending. This small to moderate effect appears to be due largely to the scale items that assess impulsive behaviors and past criminal history, which are well-established but very general risk factors. The aspects of core personality often held to be distinctively psychopathic generally show little or no predictive link to crime by themselves. For example, Factor 1 of the PCL-R and Fearless dominance of the PPI-R have a smaller or no relationship to crime, including violent crime. In contrast, Factor 2 and Impulsive antisociality of the PPI-R are associated more strongly with criminality. Factor 2 has a relationship of similar strength to that of the PCL-R as a whole. The antisocial facet of the PCL-R is still predictive of future violence after controlling for past criminal behavior which, together with results regarding the PPI-R which by design does not include past criminal behavior, suggests that impulsive behaviors is an independent risk factor. Thus, the concept of psychopathy may perform poorly when attempted to be used as a general theory of crime.<ref name="gap" /><ref>{{cite journal |last=Walters |first=Glenn D. |date=April 2004 |title=The Trouble with Psychopathy as a General Theory of Crime |url=https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=204918 |url-status=live |journal=] |location=Thousand Oaks, California |publisher=] |volume=48 |issue=2 |pages=133–148 |doi=10.1177/0306624X03259472 |pmid=15070462 |s2cid=40939723 |archive-url=https://web.archive.org/web/20151119002546/https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=204918 |archive-date=November 19, 2015}}</ref>

==== Violence ====
Studies have suggested a strong correlation between psychopathy scores and ], and the PCL-R emphasizes features that are somewhat predictive of violent behavior. Researchers, however, have noted that psychopathy is dissociable from and not synonymous with violence.<ref name="gap" /><ref name="neumann1" /><ref>{{Cite news |last=Dolan |first=Eric W. |date=2023-01-28 |title=Study uncovers a surprising level of heterogeneity in psychopathy among condemned capital murderers |url=https://www.psypost.org/2023/01/study-uncovers-a-surprising-level-of-heterogeneity-in-psychopathy-among-condemned-capital-murderers-67165 |url-status=live |archive-url=https://web.archive.org/web/20230130011026/https://www.psypost.org/2023/01/study-uncovers-a-surprising-level-of-heterogeneity-in-psychopathy-among-condemned-capital-murderers-67165 |archive-date=2023-01-30 |access-date=2023-01-30 |newspaper=Psypost - Psychology News}}</ref>

It has been suggested that psychopathy is associated with "instrumental aggression", also known as predatory, proactive, or "cold-blooded" aggression, a form of aggression characterized by reduced emotion and conducted with a goal differing from but facilitated by the commission of harm.<ref>{{cite journal |last1=Glenn |first1=Andrea L. |last2=Raine |first2=Adrian |date=July 2009 |title=Psychopathy and instrumental aggression: Evolutionary, neurobiological, and legal perspectives |url=https://www.researchgate.net/publication/222427267 |url-status=live |journal=] |location=New York City |publisher=] |volume=32 |issue=4 |pages=253–258 |doi=10.1016/j.ijlp.2009.04.002 |issn=0160-2527 |pmid=19409615 |archive-url=https://web.archive.org/web/20160418062714/https://www.researchgate.net/publication/222427267_Psychopathy_and_instrumental_aggression_Evolutionary_neurological_and_legal_perspectives |archive-date=18 April 2016 |access-date=8 April 2016}}</ref><ref name="Walsh2010">{{cite journal |last1=Walsh |first1=Zach |last2=Swogger |first2=Marc T. |last3=Walsh |first3=Tiffany |last4=Kosson |first4=David S. |date=December 2007 |title=Psychopathy and violence: increasing specificity |journal=Netherlands Journal of Psychology |location=New York City |publisher=] |volume=63 |issue=4 |pages=125–132 |doi=10.1007/BF03061075 |pmc=2817979 |pmid=20148183}}</ref> One conclusion in this regard was made by a 2002 study of homicide offenders, which reported that the homicides committed by homicidal offenders with psychopathy were almost always (93.3%) primarily instrumental, significantly more than the proportion (48.4%) of those committed by non-psychopathic homicidal offenders, with the instrumentality of the homicide also correlated with the total PCL-R score of the offender as well as their scores on the Factor 1 "interpersonal-affective" dimension. However, contrary to the equating of this to mean exclusively "in cold blood", more than a third of the homicides committed by psychopathic offenders involved some component of emotional reactivity as well.<ref name="Woodworth">{{cite journal |last1=Woodworth |first1=Michael |last2=Porter |first2=Stephen |year=2002 |title=In cold blood: Characteristics of criminal homicides as a function of psychopathy |journal=] |location=Philadelphia, Pennsylvania |publisher=] |volume=111 |issue=3 |pages=436–45 |doi=10.1037/0021-843X.111.3.436 |pmid=12150419}}</ref> In any case, FBI profilers indicate that serious victim injury is generally an emotional offense, and some research supports this, at least concerning sexual offending. One study has found more serious offending by non-psychopathic offenders on average than by offenders with psychopathy (e.g. more homicides versus more armed robbery and property offenses) and another that the Affective facet of the PCL-R predicted reduced offense seriousness.<ref name="gap" />

Studies on perpetrators of ] find that abusers have high rates of psychopathy, with the prevalence estimated to be at around 15-30%. Furthermore, the commission of domestic violence is correlated with Factor 1 of the ], which describes the emotional deficits and the callous and exploitative interpersonal style found in psychopathy. The prevalence of psychopathy among domestic abusers indicate that the core characteristics of psychopathy, such as callousness, remorselessness, and a lack of close interpersonal bonds, predispose those with psychopathy to committing domestic abuse, and suggest that the domestic abuses committed by these individuals are callously perpetrated (i.e. instrumentally aggressive) rather than a case of emotional ] and therefore may not be amenable to the types of ] interventions commonly given to domestic abuse perpetrators.<ref name="Walsh2010" /><ref>{{cite journal |last1=Swogger |first1=Marc T. |last2=Walsh |first2=Zach |last3=Kosson |first3=David S. |date=May 2007 |title=Domestic violence and psychopathic traits: distinguishing the antisocial batterer from other antisocial offenders |journal=] |location=New York City |publisher=] |volume=33 |issue=3 |pages=253–260 |doi=10.1002/ab.20185 |pmid=17444531}}</ref>

Some clinicians suggest that assessment of the ] of psychopathy does not necessarily add value to violence ]. A large systematic review and meta-regression found that the PCL performed the poorest out of nine tools for ] violence. In addition, studies conducted by the authors or translators of violence prediction measures, including the PCL, show on average more positive results than those conducted by more independent investigators. Several other risk assessment instruments can predict further crime with an accuracy similar to the PCL-R and some of these are considerably easier, quicker, and less expensive to administer. This may even be done automatically by a computer simply based on data such as age, gender, number of previous convictions, and age of first conviction. Some of these assessments may also identify treatment changes and goals, identify quick changes that may help short-term management, identify more specific kinds of violence that may be at risk, and establish specific probabilities of offending for specific scores. Nonetheless, the PCL-R may continue to be popular for risk assessment because of its pioneering role and the large amount of research done using it.<ref name="gap" /><ref>{{cite book |last1=Heilbrun |first1=Kirk |title=Handbook of Psychology in Legal Contexts |year=2005 |isbn=978-0-470-01339-7 |editor1-last=Carson |editor1-first=David |pages=127–42 |chapter=Violence Risk: From Prediction to Management |doi=10.1002/0470013397.ch5 |access-date=2016-02-03 |editor2-last=Bull |editor2-first=Ray |chapter-url=https://books.google.com/books?id=jV79pP8rW8kC&pg=PA127 |archive-url=https://web.archive.org/web/20170403210529/https://books.google.com/books?id=jV79pP8rW8kC&pg=PA127 |archive-date=2017-04-03 |url-status=live |via=]}}</ref><ref name="Mills et. al">{{cite book |last1=Mills |first1=Jeremy F. |title=Clinician's Guide to Violence Risk Assessment |last2=Kroner |first2=Daryl G. |last3=Morgan |first3=Robert D. |date=2011 |publisher=] |isbn=978-1-60623-985-8 |location=New York City |pages=55–64 |chapter=Psychopathic Traits |access-date=2016-02-03 |chapter-url=https://books.google.com/books?id=3Jw-Slr65eQC&pg=PA55 |archive-url=https://web.archive.org/web/20170404083151/https://books.google.com/books?id=3Jw-Slr65eQC&pg=PA55 |archive-date=2017-04-04 |url-status=live |via=]}}</ref><ref>{{cite journal |last1=Yang |first1=Min |last2=Wong |first2=Stephen C. P. |last3=Coid |first3=Jeremy |year=2010 |title=The efficacy of violence prediction: A meta-analytic comparison of nine risk assessment tools |journal=] |location=Washington, D.C. |publisher=] |volume=136 |issue=5 |pages=740–67 |citeseerx=10.1.1.404.4396 |doi=10.1037/a0020473 |pmid=20804235}}</ref><ref name="Psychol">{{cite journal |vauthors=Singh JP, Grann M, Fazel S |date=Apr 2011 |title=A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants |journal=] |location=Oxfordshire, England |publisher=] |volume=31 |issue=3 |pages=499–513 |doi=10.1016/j.cpr.2010.11.009 |pmid=21255891}}</ref><ref>{{cite web |last=Franklin |first=Karen |date=June 19, 2011 |title=Violence risk meta-meta: Instrument choice does matter: Despite popularity, psychopathy test and actuarials not superior to other prediction methods |url=http://forensicpsychologist.blogspot.co.uk/2011/06/violence-risk-meta-meta-instrument.html |archive-url=https://web.archive.org/web/20130923062039/http://forensicpsychologist.blogspot.co.uk/2011/06/violence-risk-meta-meta-instrument.html |archive-date=September 23, 2013 |website=forensicpsychologist.blogspot.co.uk}}</ref><ref>{{cite journal |last1=Singh |first1=Jay P. |last2=Martin |first2=Grann |last3=Seena |first3=Fazel |date=September 2, 2013 |title=Authorship Bias in Violence Risk Assessment? A Systematic Review and Meta-Analysis |journal=] |location=San Francisco, California |publisher=] |volume=8 |issue=9 |page=e72484 |bibcode=2013PLoSO...872484S |doi=10.1371/journal.pone.0072484 |pmc=3759386 |pmid=24023744 |doi-access=free}}</ref>

The U.S. ] (FBI) reports that psychopathic behavior is consistent with traits common to some ]s, including sensation seeking, a lack of ] or ], ], the ], and predatory behavior.<ref name="fbi.gov">{{cite web |last=Morton |first=Robert J |title=Serial Murder |url=https://www.fbi.gov/stats-services/publications/serial-murder |url-status=live |archive-url=https://web.archive.org/web/20101028051224/http://www.fbi.gov/stats-services/publications/serial-murder |archive-date=October 28, 2010 |access-date=January 1, 2011 |publisher=]}}</ref> It has also been found that the homicide victims of psychopathic offenders were disproportionately female in comparison to the more equitable gender distribution of victims of non-psychopathic offenders.<ref name="Woodworth" />

==== Sexual offending ====
Psychopathy has been associated with the commission of ], with some researchers arguing that it is correlated with a preference for violent sexual behavior. A 2011 study of conditional releases for Canadian male federal offenders found that psychopathy was related to more violent and non-violent offences but not more sexual offences.<ref>{{Cite journal |last1=Porter |first1=Stephen |last2=ten Brinke |first2=Leanne |last3=Wilson |first3=Kevin |date=January 10, 2011 |title=Crime profiles and conditional release performance of psychopathic and non-psychopathic sexual offenders |url=https://bpspsychub.onlinelibrary.wiley.com/doi/10.1348/135532508X284310 |url-status=live |journal=Legal and Criminological Psychology |volume=14 |issue=1 |pages=109–118 |doi=10.1348/135532508X284310 |issn=1355-3259 |archive-url=https://web.archive.org/web/20231230021825/https://bpspsychub.onlinelibrary.wiley.com/doi/10.1348/135532508X284310 |archive-date=December 30, 2023 |access-date=December 30, 2023}}</ref> For ], psychopathy was associated with more offences.<ref name="Porter2009">{{cite journal |last1=Porter |first1=Stephen |last2=Brinke |first2=Leanne |last3=Wilson |first3=Kevin |year=2009 |title=Crime profiles and conditional release performance of psychopathic and non-psychopathic sexual offenders |journal=] |volume=14 |issue=1 |pages=109–18 |doi=10.1348/135532508X284310}}</ref> A study on the relationship between psychopathy scores and types of aggression in a sample of sexual murderers, in which 84.2% of the sample had PCL-R scores above 20 and 47.4% above 30, found that 82.4% of those with scores above 30 had engaged in ] violence (defined as enjoyment indicated by self-report or evidence) compared to 52.6% of those with scores below 30, and total PCL-R and Factor 1 scores correlated significantly with sadistic violence.<ref>{{cite journal |last1=Williams |first1=Kevin M. |last2=Cooper |first2=Barry S. |last3=Howell |first3=Teresa M. |last4=Yuille |first4=John C. |last5=Paulhus |first5=Delroy L. |year=2008 |title=Inferring Sexually Deviant Behavior from Corresponding Fantasies: The Role of Personality and Pornography Consumption |journal=] |volume=36 |issue=2 |pages=198–22 |doi=10.1177/0093854808327277 |s2cid=33364099}}</ref><ref>{{cite journal |last1=Porter |first1=Stephen |last2=Woodworth |first2=Michael |last3=Earle |first3=Jeff |last4=Drugge |first4=Jeff |last5=Boer |first5=Douglas |year=2003 |title=Characteristics of sexual homicides committed by psychopathic and nonpsychopathic offenders |journal=Law and Human Behavior |volume=27 |issue=5 |pages=459–70 |doi=10.1023/A:1025461421791 |pmid=14593792 |s2cid=486057}}</ref> Despite this, it is reported that offenders with psychopathy (both sexual and non-sexual offenders) are about 2.5 times more likely to be granted conditional release compared to non-psychopathic offenders.<ref name="Porter2009" />

Hildebrand and colleagues (2004) have uncovered an interaction between psychopathy and ], wherein those high in psychopathy who also endorsed deviant sexual interests were more likely to recidivate sexually.<ref>{{Cite journal |last1=Hildebrand |first1=Martin |last2=de Ruiter |first2=Corine |last3=de Vogel |first3=Vivienne |year=2004 |title=Psychopathy and Sexual Deviance in Treated Rapists: Association With Sexual and Nonsexual Recidivism |url=http://journals.sagepub.com/doi/10.1177/107906320401600101 |url-status=live |journal=Sexual Abuse: A Journal of Research and Treatment |volume=16 |issue=1 |pages=1–24 |doi=10.1177/107906320401600101 |issn=1079-0632 |pmid=15017823 |s2cid=36102945 |archive-url=https://web.archive.org/web/20200616085134/https://journals.sagepub.com/doi/10.1177/107906320401600101 |archive-date=2020-06-16 |access-date=2020-09-24}}</ref> A subsequent ] has consolidated such a result.<ref>{{Cite journal |last1=Hawes |first1=Samuel W. |last2=Boccaccini |first2=Marcus T. |last3=Murrie |first3=Daniel C. |year=2013 |title=Psychopathy and the combination of psychopathy and sexual deviance as predictors of sexual recidivism: Meta-analytic findings using the Psychopathy Checklist—Revised. |url=http://doi.apa.org/getdoi.cfm?doi=10.1037/a0030391 |url-status=live |journal=Psychological Assessment |volume=25 |issue=1 |pages=233–243 |doi=10.1037/a0030391 |issn=1939-134X |pmid=23088204 |archive-url=https://web.archive.org/web/20200825220849/https://doi.apa.org/doiLanding?doi=10.1037%2Fa0030391 |archive-date=2020-08-25 |access-date=2022-01-25}}</ref>

In considering the issue of possible reunification of some ] into homes with a non-offending parent and children, it has been advised that any sex offender with a significant criminal history should be assessed on the PCL-R, and if they score 18 or higher, then they should be excluded from any consideration of being placed in a home with children under any circumstances.<ref>{{cite book |last1=Levenson |first1=Jill S. |title=Treating Non-offending Parents in Child Sexual Abuse Cases |last2=Morin |first2=John W. |publisher=SAGE |year=2000 |isbn=978-0-7619-2192-9 |page=7}}</ref> There is, however, increasing concern that PCL scores are too inconsistent between different examiners, including in its use to evaluate sex offenders.<ref>{{cite journal |author=Edens John F |year=2010 |title=Inter-rater reliability of the PCL-R total and factor scores among psychopathic sex offenders: are personality features more prone to disagreement than behavioral features? |journal=Behavioral Sciences |volume=28 |issue=1 |pages=106–119 |doi=10.1002/bsl.918 |pmid=20101592}}</ref>

==== Other offending ====
{{see also|#In the workplace}}

The possibility of psychopathy has been associated with ], ], and ]s. ] are sometimes considered psychopathic, and comparisons may be drawn with traits such as antisocial violence, a selfish worldview that precludes the welfare of others, a lack of remorse or guilt, and ] externalization.<ref>{{cite journal |last1=Piccinni |first1=Armando |last2=Marazziti |first2=Donatella |last3=Veltri |first3=Antonello |date=April 2018 |title=Psychopathology of terrorists |journal=CNS Spectrums |volume=23 |issue=2 |pages=141–144 |doi=10.1017/S1092852917000645 |pmid=28931447 |s2cid=4968732}}</ref> However, John Horgan, author of ''The Psychology of Terrorism'', argues that such comparisons could also then be drawn more widely: for example, to soldiers in wars. Coordinated terrorist activity requires organization, loyalty, and ] fanaticism often to the extreme of sacrificing oneself for an ideological cause. Traits such as a self-centered disposition, unreliability, poor behavioral controls, and unusual behaviors may disadvantage or preclude psychopathic individuals from conducting organized terrorism.<ref>{{cite book |title=Psychopathy and Law: A Practitioners Guide |publisher=] |year=2012 |isbn=978-0-470-97238-0 |editor1-last=Häkkänen-Nyholm |editor1-first=Helinä |page=177 |editor2-last=Nyholm |editor2-first=Jan-Olof}}</ref><ref>{{cite book |last=Horgan |first=John |title=The Psychology of Terrorism |publisher=] |year=2005 |isbn=978-0-7146-5262-7 |page=49}}</ref>

It may be that a significant portion of people with psychopathy are socially successful and tend to express their antisocial behavior through more covert avenues such as social manipulation or ]. Such individuals are sometimes referred to as "successful psychopaths", and may not necessarily always have extensive histories of traditional antisocial behavior as characteristic of traditional psychopathy.<ref name="Successful and unsuccessful" />

=== Childhood and adolescent precursors ===
The PCL:YV is an adaptation of the PCL-R for individuals aged 13–18 years. It is, like the PCL-R, done by a trained rater based on an interview and an examination of criminal and other records. The "Antisocial Process Screening Device" (APSD) is also an adaptation of the PCL-R. It can be administered by parents or teachers for individuals aged 6–13 years. High psychopathy scores for both juveniles (as measured with these instruments) and adults (as measured with the PCL-R and other measurement tools) have similar associations with other variables, including similar ability in predicting violence and criminality.<ref name="gap" /><ref name="hare scale pclyv">{{cite web |last=Hare |first=Robert |title=Psychopathy Scales: PCL:YV |url=http://www.hare.org/scales/pclyv.html |url-status=live |archive-url=https://web.archive.org/web/20140810204223/http://www.hare.org/scales/pclyv.html |archive-date=August 10, 2014 |access-date=January 5, 2014 |website=Without Conscience}}</ref><ref name="hare scale apsd">{{cite web |last=Hare |first=Robert |title=Psychopathy Scales: APSD |url=http://www.hare.org/scales/apsd.html |url-status=live |archive-url=https://web.archive.org/web/20131103020830/http://www.hare.org/scales/apsd.html |archive-date=November 3, 2013 |access-date=January 5, 2014 |website=Without Conscience}}</ref> Juvenile psychopathy may also be associated with more negative emotionality such as anger, hostility, anxiety, and depression.<ref name="gap" /><ref>{{Cite journal |last1=Bartels |first1=M. |last2=Hudziak |first2=J. J. |last3=van den Oord |first3=E. J. C. G. |last4=van Beijsterveldt |first4=C. E. M. |last5=Rietveld |first5=M. J. H. |last6=Boomsma |first6=D. I. |date=2003-09-01 |title=Co-occurrence of Aggressive Behavior and Rule-Breaking Behavior at Age 12: Multi-Rater Analyses |url=https://research.vu.nl/en/publications/4a033802-36e1-4375-a139-1e3e50362e6f |url-status=live |journal=] |volume=33 |issue=5 |pages=607–621 |doi=10.1023/a:1025787019702 |issn=0001-8244 |pmid=14574136 |s2cid=8480586 |archive-url=https://web.archive.org/web/20201014230503/https://research.vu.nl/en/publications/co-occurrence-of-aggressive-behavior-and-rule-breaking-behavior-a |archive-date=2020-10-14 |access-date=2018-10-25}}</ref> Psychopathic traits in youth typically comprise three factors: callous/unemotional, narcissism, and impulsivity/irresponsibility.<ref>{{Cite journal |last1=Roose |first1=Annelore |last2=Bijttebier |first2=Patricia |last3=Van der Oord |first3=Saskia |last4=Claes |first4=Laurence |last5=Lilienfeld |first5=Scott O. |date=2013-01-01 |title=Psychopathic Traits in Youth and Associations with Temperamental Features |journal=Journal of Individual Differences |volume=34 |issue=1 |pages=1–7 |doi=10.1027/1614-0001/a000090 |issn=1614-0001 |s2cid=145437921}}</ref><ref>{{Cite journal |last1=Hyde |first1=Luke W. |last2=Waller |first2=Rebecca |last3=Trentacosta |first3=Christopher J. |last4=Shaw |first4=Daniel S. |last5=Neiderhiser |first5=Jenae M. |last6=Ganiban |first6=Jody M. |last7=Reiss |first7=David |last8=Leve |first8=Leslie D. |date=2016-04-08 |title=Heritable and Nonheritable Pathways to Early Callous-Unemotional Behaviors |journal=] |volume=173 |issue=9 |pages=903–910 |doi=10.1176/appi.ajp.2016.15111381 |issn=0002-953X |pmc=5008992 |pmid=27056607}}</ref>

There is a positive correlation between early negative life events of the ages 0–4 and the emotion-based aspects of psychopathy.<ref name=":2">{{Cite news |date=2017-01-21 |title=The Science of Preventing Dangerous Psychopathy |url=https://psychcentral.com/blog/the-science-of-preventing-dangerous-psychopathy/ |url-status=live |archive-url=https://web.archive.org/web/20180216143815/https://psychcentral.com/blog/the-science-of-preventing-dangerous-psychopathy/ |archive-date=2018-02-16 |access-date=2018-02-16 |work=World of Psychology}}</ref> There are moderate to high correlations between psychopathy rankings from late childhood to early adolescence. The correlations are considerably lower from early- or mid-adolescence to adulthood. In one study most of the similarities were on the Impulsive- and Antisocial-Behavior scales. Of those adolescents who scored in the top 5% highest psychopathy scores at age 13, less than one-third (29%) were classified as psychopathic at age 24. Some recent studies have also found a poorer ability to predict long-term, adult offending.<ref name="gap" /><ref>{{Cite journal |last1=Hawes |first1=Samuel W. |last2=Byrd |first2=Amy L. |last3=Waller |first3=Rebecca |last4=Lynam |first4=Donald R. |last5=Pardini |first5=Dustin A. |date=2017-01-01 |title=Late childhood interpersonal callousness and conduct problem trajectories interact to predict adult psychopathy |journal=] |volume=58 |issue=1 |pages=55–63 |doi=10.1111/jcpp.12598 |issn=1469-7610 |pmc=5340563 |pmid=27516046}}</ref>

==== Conduct disorder ====
{{Main|Conduct disorder}}

Conduct disorder is diagnosed based on a prolonged pattern of antisocial behavior in childhood and/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 psy{{shy}}chopa{{shy}}thy.<ref name="gap" /><ref name="Hinshaw">Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (pp. 144-198). New York: Guilford Press.</ref><ref>{{Cite book |last=American Psychiatric Association |url=https://archive.org/details/diagnosticstatis0005unse/page/659 |title=Diagnostic and Statistical Manual of Mental Disorders |publisher=] |year=2013 |isbn=978-0-89042-555-8 |edition=Fifth |location=Arlington, VA |pages=}}</ref> The DSM allows differentiating between childhood onset before age 10 and adolescent onset at age 10 and later. Childhood-onset is argued to be more due to a personality disorder caused by neurological deficits interacting with an adverse environment. For many, but not all, childhood onset is associated with what is in ] referred to as "life-course- persistent" antisocial behavior as well as poorer health and economic status. Adolescent onset is argued to more typically be associated with short-term antisocial behavior.<ref name="gap" />

It has been suggested that the combination of early-onset conduct disorder and ] may be associated with life-course-persistent antisocial behaviors as well as psychopathy. There is evidence that this combination is more aggressive and antisocial than those with conduct disorder alone. However, it is not a particularly distinct group since the vast majority of young children with conduct disorder also have ADHD. Some evidence indicates that this group has deficits in behavioral inhibition, similar to that of adults with psychopathy. They may not be more likely than those with conduct disorder alone to have the interpersonal/affective features and the deficits in emotional processing characteristic of adults with psychopathy. Proponents of different types/dimensions of psychopathy have seen this type as possibly corresponding to adult secondary psychopathy and increased disinhibition in the triarchic model.<ref name="gap" />

The ] includes a specifier for those with conduct disorder who also display a ] across multiple settings and relationships.<ref name=":2" /> The specifier is based on research that suggests that those with conduct disorder who also meet the criteria for the specifier tend to have a more severe form of the disorder with an earlier onset as well as a different response to treatment. Proponents of different types/dimensions of psychopathy have seen this as possibly corresponding to adult primary psychopathy and increased boldness and/or meanness in the triarchic model.<ref name="gap" /><ref name="dsm-5 cd changes">{{cite web |year=2013 |title=Highlights of Changes from DSM-IV-TR to DSM-5 |url=http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf |url-status=live |archive-url=https://web.archive.org/web/20131019204551/http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf |archive-date=October 19, 2013 |access-date=January 5, 2014 |website=DSM-5 Development |publisher=]}}</ref>

=== Mental traits ===

==== Cognition ====
Dysfunctions in the ] and ] regions of the brain have been associated with specific learning impairments in psychopathy. Damage to the ventromedial prefrontal cortex, which regulates the activity in the amygdala, leads to common characteristics in psychopathic individuals.<ref>{{cite journal |last1=Motzkin, J. C., Philippi, C. L., Wolf, R. C., Baskaya, M. K., & Koenigs, M. |date=Feb 1, 2015 |title=Ventromedial prefrontal cortex is critical for the regulation of amygdala activity in humans. |journal=Biological Psychiatry |volume=77 |issue=3 |pages=276–284 |doi=10.1016/j.biopsych.2014.02.014 |pmc=4145052 |pmid=24673881}}</ref> Since the 1980s, scientists have linked ], including damage to these regions, with violent and psychopathic behavior. Patients with damage in such areas resembled "psychopathic individuals" whose brains were incapable of acquiring social and moral knowledge; those who acquired damage as children may have trouble conceptualizing social or moral reasoning, while those with adult-acquired damage may be aware of proper social and moral conduct but be unable to behave appropriately. Dysfunctions in the amygdala and ] may also impair ] in psychopaths, whether punishment-based or reward-based. People scoring 25 or higher in the PCL-R, with an associated history of violent behavior, appear to have significantly reduced mean microstructural integrity in their ]—] connecting the amygdala and ]. There is evidence from ] of breakdowns in the white matter connections between these two important areas.<ref name="Protect – Watch Your Head" /><ref name="pmid18434283" /><ref name="pmid19506560">{{cite journal |last1=Craig |first1=M C |last2=Catani |first2=M |last3=Deeley |first3=Q |last4=Latham |first4=R |last5=Daly |first5=E |last6=Kanaan |first6=R |last7=Picchioni |first7=M |last8=McGuire |first8=P K |last9=Fahy |first9=T |last10=Murphy |first10=D G M |year=2009 |title=Altered connections on the road to psychopathy |journal=] |volume=14 |issue=10 |pages=946–53, 907 |doi=10.1038/mp.2009.40 |pmid=19506560 |doi-access=free}}</ref>

Although some studies have suggested ]s between psychopathy and ], including with regards to verbal IQ, Hare and Neumann state that a large literature demonstrates at most only a weak association between psychopathy and ], noting that the early pioneer Cleckley included good intelligence in his checklist due to ] (since many of his patients were "well educated and from middle-class or upper-class backgrounds") and that "there is no obvious theoretical reason why the disorder described by Cleckley or other clinicians should be related to intelligence; some psychopaths are bright, others less so". Studies also indicate that different aspects of the definition of psychopathy (e.g. interpersonal, affective (emotion), behavioral, and lifestyle components) can show different links to intelligence, and the result can depend on the type of intelligence assessment (e.g. verbal, creative, practical, analytical).<ref name="LecterMyth" /><ref name="neumann1" /><ref name="HareNeumann2008" /><ref>{{cite journal |last1=Sharratt |first1=Kafhryn |date=22 Feb 2019 |title=Clarifying the Relationship between Psychopathy and Intelligence Using Four Dimensions of the WASI-II |url=https://pure.hud.ac.uk/ws/files/15814564/Clarifying_the_Relationship_between_Psychopathy_and_Intelligence_using_Four_Dimensions_of_the_WASI_II.pdf |url-status=live |journal=Deviant Behavior |volume=41 |issue=5 |pages=619–627 |doi=10.1080/01639625.2019.1582968 |s2cid=150699596 |archive-url=https://web.archive.org/web/20210126120315/https://pure.hud.ac.uk/ws/files/15814564/Clarifying_the_Relationship_between_Psychopathy_and_Intelligence_using_Four_Dimensions_of_the_WASI_II.pdf |archive-date=26 January 2021 |access-date=29 August 2020}}</ref>

==== Emotion recognition and empathy ====
A large body of research suggests that psychopathy is associated with atypical responses to distress ] from other people, more precisely an impaired emotional ] in the recognition of, and response to, ], ] and ] of ], ], ] and ].<ref name="Blair2018">{{cite book |last1=Blair |first1=R. J. R. |title=Handbook of psychopathy |last2=Meffert |first2=H. |last3=Hwang |first3=S. |last4=White |first4=S. F. |date=2018 |publisher=] |editor1-last=Patrick |editor1-first=C. J. |edition=2nd |pages=401–421 |chapter=Psychopathy and brain function: Insights from neuroimaging research}}</ref><ref name=":0" /> This impaired recognition and reduced autonomic responsiveness might be partly accounted for by a decreased activation of the ] and ] regions.<ref name=":0" /> The underlying biological surfaces for processing expressions of happiness are functionally intact in psychopaths, although less responsive than those of controls. The neuroimaging literature is unclear as to whether deficits are specific to particular emotions such as fear. The overall pattern of results across studies indicates that people diagnosed with psychopathy demonstrate reduced MRI, fMRI, aMRI, PET, and SPECT activity in areas of the brain.<ref>{{Cite journal |last=Nickerson |first=Sherry |title=Brain Abnormalities in Psychopaths: A Meta-Analysis |journal=] |volume=16 |pages=63–77}}</ref> Research has also shown that an approximate 18% smaller amygdala size contributes to a significantly lower emotional sensation in regards to fear, sadness, amongst other negative emotions, which may likely be the reason as to why psychopathic individuals have lower empathy.<ref>{{Cite journal |last1=Yang |first1=Yaling |last2=Raine |first2=Adrian |last3=Narr |first3=Katherine L. |last4=Colletti |first4=Patrick |last5=Toga |first5=Arthur W. |date=September 2009 |title=Localization of Deformations Within the Amygdala in Individuals With Psychopathy |journal=] |volume=66 |issue=9 |pages=986–994 |doi=10.1001/archgenpsychiatry.2009.110 |issn=0003-990X |pmc=3192811 |pmid=19736355}}</ref> Some recent fMRI studies have reported that emotion perception deficits in psychopathy are pervasive across emotions (positives and negatives).<ref>Decety, J., & Skelly, L. (2013). The neural underpinnings of the experience of empathy: Lessons for psychopathy. In K. N. Ochsner and S. M. Kosslyn (Eds.), The Oxford Handbook of Cognitive Neuroscience – Volume 2 (pp. 228-243). New York: Oxford University Press.</ref><ref name="Kiehl2006">{{cite journal |author=Kiehl K. A. |year=2006 |title=A cognitive neuroscience perspective on psychopathy: Evidence for paralimbic system dysfunction |journal=Psychiatry Research |volume=142 |issue=2–3 |pages=107–128 |doi=10.1016/j.psychres.2005.09.013 |pmc=2765815 |pmid=16712954}}</ref><ref name="Blair 1995">{{cite journal |last=Blair |first=R.J. |year=1995 |title=A cognitive developmental approach to morality: investigating the psychopath. |url=http://www.unc.edu/~knobe/PHIL109/blair.pdf |url-status=live |journal=Cognition |volume=57 |issue=1 |pages=1–29 |doi=10.1016/0010-0277(95)00676-p |pmid=7587017 |s2cid=16366546 |archive-url=https://web.archive.org/web/20130721140948/http://www.unc.edu/~knobe/PHIL109/blair.pdf |archive-date=2013-07-21}}</ref><ref name="Blair2002" /><ref name="Quinton">"Psychopathy" by Quinton 2006</ref> Studies on children with psychopathic tendencies have also shown such associations.<ref name="Quinton" /><ref name="Blair 2001a">{{cite journal |last=Blair |first=R.J. |author2=E. Colledge |author3=D.G. Mitchell |date=2001a |title=Somatic markers and response reversal: is there orbitofrontal cortex dysfunction in boys with psychopathic tendencies? |journal=Journal of Abnormal Child Psychology |volume=29 |issue=6 |pages=499–511 |doi=10.1023/A:1012277125119 |pmid=11761284 |s2cid=1951812}}</ref><ref name="Blair 2002">{{cite journal |last1=Blair |first1=R. J. |last2=Mitchell |first2=D.G. |last3=Richell |first3=R.A. |display-authors=etal |year=2002 |title=Turning a deaf ear to fear: impaired recognition of vocal affect in psychopathic individuals |url=https://zenodo.org/record/1231468 |url-status=live |journal=] |volume=111 |issue=4 |pages=682–686 |doi=10.1037/0021-843x.111.4.682 |pmid=12428783 |archive-url=https://web.archive.org/web/20201012171631/https://zenodo.org/record/1231468 |archive-date=2020-10-12 |access-date=2020-08-23}}</ref><ref name="Stevens 2001">{{cite journal |last1=Stevens |first1=D. |last2=Charman |first2=T. |last3=Blair |first3=R.J. |year=2001 |title=Recognition of emotion in facial expressions and vocal tones in children with psychopathic tendencies |journal=] |volume=162 |issue=2 |pages=201–11 |doi=10.1080/00221320109597961 |pmid=11432605 |s2cid=42581610}}</ref><ref>{{cite journal |author1=Decety L. |author2=Skelly L. R. |author3=Yoder K. J. |author4=Kiehl K. |year=2014 |title=Neural processing of dynamic facial expressions in psychopaths |journal=Social Neuroscience |volume=9 |issue=1 |pages=36–49 |doi=10.1080/17470919.2013.866905 |pmc=3970241 |pmid=24359488}}</ref><ref name="Dawel 2012">{{Cite journal |last1=Dawel |first1=Amy |last2=O'Kearney |first2=Richard |last3=McKone |first3=Elinor |last4=Palermo |first4=Romina |date=2012-11-01 |title=Not just fear and sadness: meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy |journal=] |volume=36 |issue=10 |pages=2288–2304 |doi=10.1016/j.neubiorev.2012.08.006 |issn=1873-7528 |pmid=22944264 |s2cid=2596760}}</ref> Meta-analyses have also found evidence of impairments in both vocal and facial emotional recognition for several emotions (i.e., not only fear and sadness) in both adults and children/adolescents.<ref name="Dawel 2012" />

==== Moral judgment ====
Psychopathy has been associated with ]—an absence of, indifference towards, or disregard for moral beliefs. There are few firm data on patterns of moral judgment. Studies of the developmental level (sophistication) of moral reasoning found all possible results—lower, higher or the same as non-psychopaths. Studies that compared judgments of personal moral transgressions versus judgments of breaking conventional rules or laws found that psychopaths rated them as equally severe, whereas non-psychopaths rated the rule-breaking as less severe.<ref name="KoenigsKruepkeZeierNewman">{{cite journal |last1=Koenigs |first1=M. |last2=Kruepke |first2=M. |last3=Zeier |first3=J. |last4=Newman |first4=J. P. |year=2011 |title=Utilitarian moral judgment in psychopathy |journal=] |volume=7 |issue=6 |pages=708–14 |doi=10.1093/scan/nsr048 |pmc=3427868 |pmid=21768207}}</ref>


A study comparing judgments of whether personal or impersonal harm would be endorsed to achieve the rational maximum (]) amount of welfare found no significant differences between subjects high and low in psychopathy. However, a further study using the same tests found that prisoners scoring high on the PCL were more likely to endorse impersonal harm or rule violations than non-psychopathic controls were. The psychopathic offenders who scored low in anxiety were also more willing to endorse personal harm on average.<ref name="KoenigsKruepkeZeierNewman" />
Though in widespread use, psychopathy has no precise equivalent<ref name=hare1>Hare, R. D. Accessed ], ]</ref> in either the ], where it is most strongly correlated with the diagnosis of ], or the ], where it is correlated with ]. Experts such as research psychologist ] are working toward ] psychopathy as a unique disorder. However he has not succeeded and the term has been dropped in favor of Antisocial Personality Disorder. However, only a minority of diagnosable psychopaths who are in institutions are violent offenders.<ref>Belmore, M. F., & Quinsey, V. L. Correlates of psychopathy in a noninstitutional sample. Journal of Interpersonal Violence, 9(3), 339-349 1994</ref><ref>Hersh, K., & Gray-Little, B. Psychopathic traits and attitudes associated with self-reported sexual aggression in college men. Journal of Interpersonal Violence, 13(4), 456-471 1998</ref> The manipulative skills of some of the others are valued for providing audacious leadership.<ref> Hercz, R 'Psychopaths among us.' 2001 retrieved from </ref> It is argued that psychopathy is adaptive in a highly competitive environment, because it gets results for both the individual and the corporations<ref>Babiak, P. Psychopathic manipulation in organizations: Pawns, patrons, and patsies </ref><ref>D. J. Cooke, Rache 71-99, lizbet1998 </ref><ref>A. E. Forth, J. P. Newman, & R. D. Hare (Eds.), Issues in criminological and legal psychology: No. 24, International perspective on psychopathy (pp. 12-17). Leicester, UK: British Psychological Society. 1996 </ref> or, often small political sects that they represent.<ref>Mealey. L. 'The Sociobiology of Sociopathy: An Integrated Evolutionary Model' retrieved from </ref> However, these individuals will often cause long-term harm, both to their co-workers and the organization as a whole, due their manipulative, deceitful, abusive, and often fraudulent behaviour.<ref>Babiak, P. From darkness into the light: Psychopathy in industrial and organizational psychology. In Herve, H. & Yuille, J.C. (Eds.), The Psychopath: Theory, Research and Practice. Mahwah, NJ: Lawrence Erlbaum Associates. 2007</ref>


Assessing accidents, where one person harmed another unintentionally, psychopaths judged such actions to be more morally permissible. This result has been considered a reflection of psychopaths' failure to appreciate the emotional aspect of the victim's harmful experience.<ref>{{cite journal |last1=Young |first1=Liane |last2=Koenigs |first2=Michael |last3=Kruepke |first3=Michael |last4=Newman |first4=Joseph P. |year=2012 |title=Psychopathy increases perceived moral permissibility of accidents |url=http://moralitylab.bc.edu/wp-content/uploads/2011/10/YoungKoenigsPsychopathy.pdf |url-status=live |journal=] |volume=121 |issue=3 |pages=659–67 |doi=10.1037/a0027489 |pmc=4603562 |pmid=22390288 |archive-url=https://web.archive.org/web/20130406201911/http://moralitylab.bc.edu/wp-content/uploads/2011/10/YoungKoenigsPsychopathy.pdf |archive-date=2013-04-06}}</ref>
In current clinical use, psychopathy is most commonly diagnosed using the ] devised by Emeritus Professor ]. He describes psychopaths as "intraspecies predators<ref>{{cite journal |author=Ochberg FM, Brantley AC, Hare RD, ''et al'' |title=Lethal predators: psychopathic, sadistic, and sane |journal=International journal of emergency mental health |volume=5 |issue=3 |pages=121-36 |year=2003 |pmid=14608825 |doi=}}</ref><ref>Simon, R. I. Psychopaths, the predators among us. In R. I. Simon (Ed.) Bad Men Do What Good Men Dream (pp. 21-46). Washington: American Psychiatric Publishing, Inc.1996</ref> who use charm, ], ], and violence<ref>D. J. Cooke, A. E. Forth, & R. D. Hare (Eds.), Psychopathy: Theory, research, and implications for society Dordrecht, The Netherlands: Kluwer</ref><ref>Heilbrun, K. Violence risk: From prediction to management. In D. Carson & R. Bull (Eds.), Handbook of psychology in legal contexts, 2nd edition (pp. 127-142). New York: Wiley 2003 </ref><ref>Harris, G. T., Rice, M. E., & Lalumiére, M. Criminal violence: The roles of psychopathy, neurodevelopmental insults, and antisocial parenting. Criminal Justice and Behavior, 28(4), 402-426 2001.</ref> to control others and to satisfy their own selfish needs. Lacking in conscience and in feelings for others, they take what they want and do as they please, violating social ]s and expectations without guilt or remorse".<ref name=hare2>Hare, Robert D, Psychopaths: New Trends in Research. The Harvard Mental Health Letter, September 1995</ref> "What is missing, in other words, are the very qualities that allow a human being to live in social harmony."<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 2.</ref>
<!-- does anyone specifically DISPUTE Hare's definition? -->


== History == == History ==
{{Main|History of psychopathy}}
Research into a group of individuals that could be described as psychopathic was first completed by ] almost 200 years ago. Pinel described patients as "insane without delirium," which he characterized as a lack of restraint and remorselessness for their actions. Pinel felt that his patients were morally neutral, reflecting his ] approach to mental illness.<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 25.</ref> The 19th century term used for such individuals was "moral imbecile"<ref> David Kelley, "Stalking the Criminal Mind", ''Harper's'', Aug. 1985, 53-59.</ref>


=== Etymology ===
The next most distinctive work on psychopaths was done in 1941 by ] in his book '']'' (significantly expanded in the second edition of 1950). Cleckley offered a broad range of case histories, from all corners of society, all of which showed patients with the common characteristic of "emotional emptiness."<ref name=cleckley>Cleckley, Hervey. ''The Mask of Sanity,'' pg 92.</ref> Cleckley probed the psychopath's attitudes and thought patterns in search of a meaning for their unusual behaviour; however, according to Robert Hare, Cleckley's most important contribution was in providing the framework of emotion for most future research into this disorder.<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 19.</ref>
The word ''psychopathy'' is a joining of the ] words ''psyche'' ({{lang|el|ψυχή}}) "soul" and ''pathos'' ({{lang|el|πάθος}}) "suffering, feeling".<ref name=":12">{{cite web |url=http://www.etymonline.com/index.php?search=psychopathy&searchmode=phrase |title=Psychopathy |website=Online Etymology Dictionary |archive-url=https://web.archive.org/web/20120113063202/http://www.etymonline.com/index.php?search=psychopathy&searchmode=phrase |archive-date=2012-01-13 |access-date=August 1, 2011}}</ref> The first documented use is from 1847 in ] as ''psychopatisch'',<ref>{{cite web |url=http://www.etymonline.com/index.php?term=psychopathic&allowed_in_frame=0 |website=Online Etymology Dictionary |title=Psychopathic |archive-url=https://web.archive.org/web/20120823172832/http://www.etymonline.com/index.php?term=psychopathic&allowed_in_frame=0 |archive-date=2012-08-23 |access-date=January 21, 2012}}</ref> and the noun ''psychopath'' has been traced to 1885.<ref name=":13">{{Cite web |url=http://www.etymonline.com/index.php?term=psychopath&allowed_in_frame=0 |website=Online Etymology Dictionary |title=Psychopath |archive-url=https://web.archive.org/web/20130920110336/http://www.etymonline.com/index.php?term=psychopath&allowed_in_frame=0 |archive-date=2013-09-20 |access-date=January 21, 2012}}</ref> In medicine, ''patho-'' has a more specific meaning of ] (Thus '']'' has meant the study of disease since 1610, and '']'' has meant the study of ] in general since 1847. A sense of "a subject of pathology, morbid, excessive" is attested from 1845,<ref name=":14">{{Cite web |url=http://www.etymonline.com/index.php?term=pathological&allowed_in_frame=0 |website=Online Etymology Dictionary |title=Pathological |archive-url=https://web.archive.org/web/20120823140630/http://www.etymonline.com/index.php?term=pathological&allowed_in_frame=0 |archive-date=2012-08-23 |access-date=January 21, 2012}}</ref> including the phrase '']'' from 1891 in the medical literature).


The term ''psychopathy'' initially had a very general meaning referring to all sorts of mental disorders and social aberrations, popularised from 1891 in Germany by ] concept of "psychopathic inferiority" ({{lang|de|psychopathische Minderwertigkeiten}}). Some medical dictionaries still define psychopathy in both a narrow and broad sense, such as ] from the U.S. ].<ref name=":15">Medlineplus {{webarchive|url=https://web.archive.org/web/20140106031526/http://www.merriam-webster.com/medlineplus/psychopath |date=2014-01-06 }} or {{webarchive|url=https://web.archive.org/web/20140106031759/http://www.merriam-webster.com/medlineplus/psychopathy |date=2014-01-06 }} Retrieved January 21st 2012</ref> On the other hand, ] defines "psychopath" only as a "former designation" for a person with an antisocial type of personality disorder.<ref name=":16">Medilexicon powered by Stedman's, part of Lippincott Williams & Wilkins {{webarchive|url=https://web.archive.org/web/20130404194127/http://www.medilexicon.com/medicaldictionary.php?t=73686 |date=2013-04-04 }} Retrieved January 21st 2012</ref>


The term '']'' was also used in Germany from 1841, originally in a very general sense. The suffix -ωσις (-osis) meant in this case "abnormal condition". This term or its adjective ''psychotic'' would come to refer to the more severe mental disturbances and then specifically to mental states or disorders characterized by ], ], or in some other sense markedly out of touch with ].<ref name=Burgy>{{cite journal |doi=10.1093/schbul/sbm136 |title=The Concept of Psychosis: Historical and Phenomenological Aspects |year=2008 |last1=Burgy |first1=M. |journal=Schizophrenia Bulletin |volume=34 |issue=6 |pages=1200–10 |pmid=18174608 |pmc=2632489}}</ref>
== Psychopath / Sociopath definition==
The prototypical psychopath has deficits or deviances in several areas: interpersonal relationships, emotion, and self-control. Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright. Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. This extends into their pathological lying and willingness to con and manipulate others for personal gain or amusement. The prototypical psychopath's emotions are described as a ''shallow affect'', meaning their overall way of relating is characterized by mere ] of friendliness and other emotion for personal gain; the displayed emotion need not correlate with felt emotion, in other words. Shallow affect also describes the psychopath's tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on ]s.<ref name=handbook>Millon, Theodore; Davis, Roger D. "Chapter 11: The Five-Factor Model of Personality, pp. 173-177. ''Psychopathy: Antisocial, Criminal, and Violent Behavior.''</ref>


The ] term '']'' has been traced to a shortening of the adjective ''psychopathic'' from 1936, and from 1942 as a shortening of the noun ''psychopath'',<ref>{{Cite web|url=https://www.etymonline.com/word/psycho|archive-url=https://web.archive.org/web/20120823143514/http://www.etymonline.com/index.php?term=psycho&allowed_in_frame=0|title=psycho &#124; Origin and meaning of psycho by Online Etymology Dictionary|archive-date=August 23, 2012|website=etymonline.com}}</ref> but it is also used as shorthand for psychotic or crazed.<ref name=":18">{{cite web |url=http://dictionary.reference.com/browse/psycho |publisher=Dictionary.com |title=Psycho |access-date=7 Sep 2013 |archive-date=19 September 2020 |archive-url=https://web.archive.org/web/20200919225646/https://www.dictionary.com/browse/psycho |url-status=live }}</ref>
Since psychopaths cause harm through their actions, it is assumed that they are not emotionally attached to the people they harm; however, according to the ], psychopaths are also careless in the way they treat themselves. They frequently fail to alter their behavior in a way that would prevent them from enduring future discomfort.


The media usually uses the term ''psychopath'' to designate any criminal whose offenses are particularly abhorrent and unnatural, but that is not its original or general psychiatric meaning.<ref name=lykken>{{cite book |last=Lykken |first=David T. |title=The Antisocial Personalities |year=1995 |publisher=Psychology Press |isbn=978-0-8058-1941-0}}{{Page needed|date=September 2010}}</ref>
Most research studies of psychopaths have taken place among prison populations. This remains a limitation on its applicability to a general population.


==== Sociopathy ====
Cleckley defined psychopathy thus:<ref name=mask>Cleckley, H, 1941 (pdf Download 1.38mb)</ref>
The word element ''socio''- has been commonly used in compound words since around 1880.<ref name="sociopathy" /><ref name="socio">{{Cite web |url=https://www.etymonline.com/word/socio- |archive-url=https://web.archive.org/web/20120822024149/http://www.etymonline.com/index.php?term=socio-&allowed_in_frame=0 |title=socio- &#124; Origin and meaning of prefix socio- |archive-date=August 22, 2012 |website=etymonline.com}}</ref> The term ''sociopathy'' may have been first introduced in 1909 in Germany by biological psychiatrist ] and in 1930 in the US by educational psychologist ], as an alternative to the concept of ''psychopathy''.<ref name="sociopathy">{{cite book |last=Rutter |first=Steve |title=The Psychopath: Theory, Research, and Practice |year=2007 |publisher=Lawrence Erlbaum Associates |location=New Jersey |isbn=978-0-8058-6079-5 |page=37}}</ref> It was used to indicate that the defining feature is violation of ], or antisocial behavior, and may be social or biological in origin.<ref> {{Webarchive|url=https://web.archive.org/web/20181116230533/https://ajp.psychiatryonline.org/action/cookieAbsent |date=2018-11-16 }} G. E. Partridge, The American Journal of Psychiatry. 1930 July; 1(87):53–99</ref><ref name=":17"> {{Webarchive|url=https://web.archive.org/web/20170103004702/https://books.google.com/books?id=C-fXBNTlk7wC |date=2017-01-03 }}, Volume 1, Alan Felthous, Henning Sass, 15 Apr 2008</ref><ref> {{Webarchive|url=https://web.archive.org/web/20170404072931/https://books.google.com/books?id=BKKwZgFHC78C |date=2017-04-04 }} Martin Hildebrand, Rozenberg Publishers, 16 Jun 2005</ref><ref> {{webarchive|url=https://web.archive.org/web/20151001022408/http://bjp.rcpsych.org/content/76/315/838.1.extract |date=2015-10-01 }}, M. Hamblin Smith, The British Journal of Psychiatry (1930) 76: 838</ref>
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{|border="2" cellpadding="4" cellspacing="0" style="margin: 1em 1em 1em 0; background: #f9f9f9; border: 1px #aaa solid; border-collapse: collapse; font-size:90%; valign:top; color:black;"
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*1. Superficial charm and good "intelligence".
*2. Absence of delusions and other signs of irrational thinking.
*3. Absence of nervousness or ] manifestations.
*4. Unreliability.
*5. Untruthfulness and insincerity.
*6. Lack of remorse or shame.
*7. Antisocial behavior without apparent compunction.
*8. Poor judgment and failure to learn from experience.
| valign=top align=left|
*9. Pathological ] and incapacity to love.
*10. General poverty in major ] reactions.
*11. Specific loss of insight.
*12. Unresponsiveness in general interpersonal relations.
*13. Fantastic and uninviting behavior with drink, and sometimes without.
*14. ] threats rarely carried out.
*15. Sex life impersonal, trivial, and poorly integrated.
*16. Failure to follow any life plan.
|}
</center>


The terms ''sociopathy'' and ''psychopathy'' were once used interchangeably concerning ], though this usage is outdated in medicine and psychiatry.<ref>{{Citation |last1=Fisher |first1=Kristy A. |title=Antisocial Personality Disorder |date=2024 |work=StatPearls |url=http://www.ncbi.nlm.nih.gov/books/NBK546673/ |access-date=2024-06-19 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31536279 |last2=Torrico |first2=Tyler J. |last3=Hany |first3=Manassa}}</ref> Psychopathy, however, is a highly popular construct in the psychology literature.<ref>{{Cite web |title=Related to Psychopathy Psychological Disorders and Diagnoses |url=https://psychopathyis.org/related-disorders/ |access-date=2024-07-10 |website=Psychopathy Is |language=en-US}}</ref> Furthermore, the DSM-5 introduced the dimensional model of personality disorders in Section III, which includes a specifier for psychopathic traits.<ref>{{Cite web |title=DSM-5 Section III |url=https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Section-III.pdf}}</ref> According to the DSM, psychopathy is not a standalone diagnosis, but the authors attempted to measure "psychopathic traits" via a specifier.<ref>{{Cite journal |last1=Latzman |first1=Robert D. |last2=Tobin |first2=Kaitlyn E. |last3=Palumbo |first3=Isabella M. |last4=Conway |first4=Christopher C. |last5=Lilienfeld |first5=Scott O. |last6=Patrick |first6=Christopher J. |last7=Krueger |first7=Robert F. |date=2020-10-01 |title=Locating psychopathy within the domain space of personality pathology |url=https://www.sciencedirect.com/science/article/pii/S0191886920303135 |journal=Personality and Individual Differences |volume=164 |pages=110124 |doi=10.1016/j.paid.2020.110124 |issn=0191-8869}}</ref> In one study, the "Psychopathic Features Specifier" has been modeled on Factor 1 of the ], known as Fearless Dominance. To some, it is evidence of psychopathy not being a more extreme version of ASPD, but as an emergent compound trait that manifests when Antisocial Personality Disorder is present in combination with high levels of Fearless Dominance (or Boldness as it's known in the Triarchic Model).<ref>{{Cite journal |last=Lilienfeld |first=Scott O. |date=2020 |title=Locating psychopathy within the domain space of personality pathology |url=https://scottlilienfeld.com/wp-content/uploads/2021/01/10.1016@j.paid_.2020.110124.pdf |journal=Personality and Individual Differences}}</ref> Analyses showed that this Section III ASPD greatly outperformed Section II ASPD in predicting scores on Hare’s (2003) Psychopathy Checklist-Revised.<ref>{{Cite journal |last=Patrick |first=Christopher |date=July 2016 |title=Examining the DSM–5 alternative personality disorder model operationalization of antisocial personality disorder and psychopathy in a male correctional sample. |url=https://awspntest.apa.org/buy/2016-10049-001 |journal=Personality Disorders: Theory, Research, and Treatment|volume=7 |issue=3 |pages=229–239 |doi=10.1037/per0000179 |pmid=26914324 }}</ref>
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 ] 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.<ref>{{citation|last1=Harris|first1=Grant|last2=Rice|first2=Marnie|contribution=Treatment of psychopathy: A review of empirical findings|editor-last=Patrick|editor-first=Christopher|title=Handbook of Psychopathy|date=2006|pages=555-572}}</ref>


Section III ASPD including the 'Psychopathic Traits Specifier' can be seen on page 765 of the DSM-5 or Page 885 of the DSM-5-TR.<ref>{{Cite web |title=Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) |url=https://repository.poltekkes-kaltim.ac.id/657/1/Diagnostic%20and%20statistical%20manual%20of%20mental%20disorders%20_%20DSM-5%20(%20PDFDrive.com%20).pdf }}</ref>
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.


The term is used in various ways in contemporary usage. ] stated in the popular science book '']'' that ''sociopathy'' and ''psychopathy'' are often used interchangeably, but in some cases the term ''sociopathy'' is preferred because it is less likely than is ''psychopathy'' to be confused with ], whereas in other cases the two terms may be used with different meanings that reflect the user's views on its origins and determinants. Hare contended that the term ''sociopathy'' is preferred by those who see the causes as due to social factors and early environment, and the term ''psychopathy'' is preferred by those who believe that there are psychological, biological, and genetic factors involved in addition to environmental factors.<ref name="Without Conscience"/> Hare also provides his own definitions: he describes psychopathy as lacking a sense of empathy or morality, but sociopathy as only differing from the average person in the sense of right and wrong.<ref>{{cite book |last=Hare |first=Robert |title=Snakes in Suits: When Psychopaths Go To Work |year=2006 |publisher=HarperCollins Publishers |location=New York, NY |isbn=978-0-06-083772-3}}</ref><ref>{{cite journal |last1=Skilling |first1=TA |first2=GT |last2=Harris |first3=ME |last3=Rice |first4=VL |last4=Quinsey |title=Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria |journal=Psychological Assessment |volume=14 |issue=1 |pages=27–38 |date=March 2002 |pmid=11911046 |doi=10.1037/1040-3590.14.1.27}}</ref>
According to Cleckley, such individuals were diagnosed in the psychiatric nomenclature of the United States as a ''psychopathic personality'' until 1952 when the term was replaced by ''sociopathic personality''. In 1968, the official terminology was changed to ''personality disorder, antisocial type''. In 1980 the DSM-III changed the term slightly to ''antisocial personality disorder'', a personality disorder being a term that officially includes a variety of maladjusted persons who are not psychotic or mentally impaired.<ref>Cleckley, Hervey. ''The Mask of Sanity,'' pg 7.</ref>


== Legal definition == === Precursors ===
] that have been connected to psychopathic traits include ] {{bibleverse-nb||Deuteronomy|21:18–21|HE}} and a ] by the Greek philosopher ] around 300 BC.<ref name=":1" />


The concept of psychopathy has been indirectly connected to the early 19th-century work of ] (1801; "mania without delirium") and ] (1835; "]"), although historians have largely discredited the idea of a direct equivalence.<ref>{{cite journal |doi=10.1177/0957154X9901003706 |pmid=11623816 |title=Classic Text No. 37: J. C. Prichard and the concept of 'moral insanity' |year=1999 |last1=Berrios |first1=G.E. |journal=History of Psychiatry |volume=10 |issue=37 |pages=111–26 |s2cid=144068583}}</ref> ''Psychopathy'' originally described any illness of the mind, but found its application to a narrow subset of mental conditions when it was used toward the end of the 19th century by the German psychiatrist ] (1891) to describe various behavioral and moral dysfunction in the absence of an obvious mental illness or ]. He applied the term ''psychopathic inferiority'' ({{lang|de|psychopathischen Minderwertigkeiten}}) to various chronic conditions and character disorders, and his work would influence the later conception of the personality disorder.<ref name="gap" /><ref>{{cite journal |doi=10.1016/0010-440X(93)90031-X |pmid=8425387 |title=European views on personality disorders: A conceptual history |year=1993 |last1=Berrios |first1=G.E. |journal=] |volume=34 |pages=14–30 |issue=1}}</ref>
Psychopathy has quite separate ] and ] definitions that should not be confused with the medical definition. Various states and nations have at various times enacted ]s 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 Accessed ], ]</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".<ref name=Washington>Washington State Legislature Accessed ], ]</ref><ref name=Washington2>Monahan, Steadman, Henry J, [Mentally Disordered Offenders: Perspectives from Law and Social Science pp 279</ref> However, courts and legistatures do not diagnose so the legal purpose of this definition is unclear.
*] enacted a psychopathic offender law in 1939<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. However, these laws were enacted years before the ] began publishing the ] which is used today for diagnosis and does not include "psychopathic offender". Hence, these laws are of historical interest only.
*In the ], "Psychopathic Disorder" is legally defined in the Mental Health Act (UK)<ref name=ukmha>The Mental Health Act (UK) Accessed ], ]</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."
<!-- examples from other nations? China? Russia? European Union? -->
<!-- example of a legal definition at odds with medical definition? -->
<!-- example of a judicial decision going against a legal definition? -->
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The term ''psychopathic'' came to be used to describe a diverse range of dysfunctional or antisocial behavior and mental and sexual deviances, including at the time ]. It was often used to imply an underlying "constitutional" or genetic origin. Disparate early descriptions likely set the stage for modern controversies about the definition of psychopathy.<ref name="gap"/>
== Types of psychopathy ==
===PCL-R Factors===
The following findings are for research purposes only, and are not used in clinical diagnosis.


=== 20th century ===
Early ] of the ] indicated that it consisted of two factors. <ref name=factorstructure>{{cite journal|author=Harpur, T. J., Hare, R. D., & Hakstian, A. R.|title=Two-factor conceptualization of psychopathy: Construct validity and assessment implications.|journal=Psychological Assessment|volume=1|issue=1|pages=6-17|year=1989}}</ref> Factor 1 capture traits dealing with the interpersonal and affective deficits of psychopathy (e.g. shallow affect, superficial charm, manipulativeness, lack of empathy) whereas Factor 2 dealt with symptoms relating to anti-social behaviour (e.g. criminal versatility, impulsiveness, irresponsibility, poor behaviour controls, juvenile delinquency).<ref name=factorstructure/> The two factors have been found to display different correlates. Factor 1 has been correlated with narcissitic personality disorder<ref name=factorstructure/>, low anxiety<ref name=factorstructure/>, low empathy <ref name=zagon>{{cite journal|author=Zagon, I. K., & Jackson, H. J.|title=Construct validity of a psychopathy measure.|journal=Personality and Individual Differences|volume=17|issue=1|pages=125-135|year=1994}}
An influential figure in shaping modern American conceptualizations of psychopathy was American psychiatrist ]. In his classic monograph, '']'' (1941), Cleckley drew on a small series of vivid case studies of psychiatric patients at a ] hospital in Georgia to describe psychopathy. Cleckley used the metaphor of the "mask" to refer to the tendency of psychopaths to appear confident, personable, and well-adjusted compared to most psychiatric patients while revealing underlying pathology through their actions over time. Cleckley formulated sixteen criteria for psychopathy.<ref name="gap"/> The Scottish psychiatrist ] had also been influential in Europe from 1939 in narrowing the diagnosis.<ref>{{cite journal |doi=10.1136/bmj.309.6958.826 |title=Who's psychopathic now? A recent report has few new solutions and calls for more research |year=1994 |last1=Bluglass |first1=R |journal=] |volume=309 |issue=6958 |pages=826 |pmid=7950601 |pmc=2541046}}</ref>
</ref>, low stress reaction <ref name=verona>{{cite journal|author=Verona, E., Patrick, C. J., & Joiner, T. E.|title=Psychopathy, Antisocial Personality, and Suicide Risk|journal=Journal of Abnormal Psychology|volume=110|issue=3|pages=462-470|year=2001}}</ref> and low suicide risk<ref name=verona/> but high scores on scales of achievement<ref name=verona/> and well-being<ref name=verona/>. In contrast, Factor 2 was found to be related to anti-social personality disorder<ref name=factorstructure/>, social deviance<ref name=factorstructure/>, sensation seeking<ref name=factorstructure/>, low socio-economic status <ref name=factorstructure/> and high risk of suicide <ref name=verona/>. The two factors are nonetheless highly correlated<ref name=factorstructure/> and there are strong indications that they do result from a single underlying disorder.<ref name=cookekosson>{{cite journal|author=Cooke, D. J., Kosson, D. S., & Michie, C.|title=Psychopathy and ethnicity: Structural, item and test generalizability of the Psychopathy Checklist-Revised (PCL-R) in caucasian and African American participants|journal=Psychological Assessment|volume=13|issue=4|pages=531-542|year=2001}}</ref> However, research has failed to replicate the two-factor model in female samples. <ref name=vitale>{{cite journal|author=Salekin, R. T., Rogers, R., & Sewell, K. W.|title=Constuct validity of psychopathy in a female offender sample: A mutlitrait-multimethode evaluation|journal=Journal of Abnormal Psychology|volume=106|issue=4|pages=576-585|year=1997}}</ref>


The diagnostic category of ''sociopathic personality'' in early editions of the ''Diagnostic and Statistical Manual'' (DSM)<ref name="DSM-IV-TR">{{Cite book |chapter-url=http://www.behavenet.com/capsules/disorders/antisocialpd.htm |chapter=Antisocial personality disorder |archive-url=https://web.archive.org/web/20120211144219/http://www.behavenet.com/capsules/disorders/antisocialpd.htm |archive-date=2012-02-11 |title=] |edition=Fourth, Text Revision (DSM-IV-TR) |publisher=] |date=2000 |pages=645–650}}</ref> had some key similarities to Cleckley's ideas, though in 1980 when renamed Antisocial Personality Disorder some of the underlying personality assumptions were removed.<ref name="Handbook of Psychopathy"/> In 1980, Canadian psychologist Robert D. Hare introduced an alternative measure, the "]" (PCL) based largely on Cleckley's criteria, which was revised in 1991 (PCL-R),<ref name="pcl-r">{{cite book |last=Hare |first=R. D. |year=2003 |title=Manual for the Revised Psychopathy Checklist |edition=2nd |location=Toronto, ON, Canada |publisher=Multi-Health Systems}}{{page needed|date=September 2013}}</ref><ref>{{Cite news |url=https://www.independent.co.uk/life-style/health-and-families/psychopathic-traits-cultures-different-psychopath-personality-us-america-netherlands-a8206221.html |title=Psychopathic traits differ between cultures, experts claim |date=2018-02-12 |work=] |access-date=2018-02-16 |url-status=live |archive-url=https://web.archive.org/web/20180216090626/http://www.independent.co.uk/life-style/health-and-families/psychopathic-traits-cultures-different-psychopath-personality-us-america-netherlands-a8206221.html |archive-date=2018-02-16}}</ref> and is the most widely used measure of psychopathy.<ref>{{cite book |first1=Leam |last1=Craig |first2=Kevin |last2=Browne |first3=Anthony R. |last3=Beech |year=2008 |title=Assessing Risk in Sex Offenders |page=117 |publisher=] |isbn=978-0-470-01898-9}}</ref> There are also several ] tests, with the Psychopathic Personality Inventory (PPI) used more often among these in contemporary adult research.<ref name="gap" />
Recent statistical analysis using ] by Cooke and Michie <ref name=cookemichie>{{cite journal|author=Cooke, D. J., & Michie, C. (2001)|title=Refining the construct of psychopathy: Towards a hierarchical model|journal=Psychological Assessment|volume=13|issue=2|pages=171-188|year=2001}}</ref> indicated a three-factor structure, with those items from factor 2 strictly relating to anti-social behaviour (criminal versatility, juvenile delinquency, revocation of conditional release, early behavioural problems and poor behavioural controls) removed from the final model. The remain items divided into three factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience and Impulsive and Irresponsible Behavioural Style <ref name=cookemichie/>. In the most recent edition of the PCL-R, Hare adds a fourth Antisocial behaviour factor, consisting of those Factor 2 items excluded in the previous model <ref>{{cite book|author=Hare, R. D.|title=Manual for the Hare Psychopathy Checklist - Revised.|publisher=Multi-Health Systems|year=2003}}</ref>. Again, these models are presumed to be hierarchical with a single unified psychopathy disorder underlying the distinct but correlated factors.<ref>{{cite journal|author=Cooke, D. J., Michie, C., & Skeem, J. L. (2007)|title=Understanding the structure of the Psychopathy Checklist - Revised: An exploration of methodological confusion|journal=British Journal of Psychiatry|volume=190|issue=suppl. 49|pages=s39-s50|year=2007}}</ref>


Famous individuals have sometimes been diagnosed, albeit at a distance, as psychopaths. As one example out of many possible from history, in a 1972 version of a secret report originally prepared for the ] in 1943, which may have been intended to be used as ],<ref> Bradley F Smith. Times Books. 1983</ref><ref name="Spark"> {{Webarchive|url=https://web.archive.org/web/20200806184801/https://kuscholarworks.ku.edu/bitstream/handle/1808/5160/STARV22N1-2A5.pdf;jsessionid=0A0594A705BD3202193128FB1F6555E0?sequence=1 |date=2020-08-06 }} Spark, Clare L. Social Thought and Research, Volume 22, Number 1&2 (1999), pp. 113-137</ref> non-medical ] ] suggested ] was ].<ref name="psycho" >{{cite book |last=Langer |first=Walter C. |title=The Mind of Adolf Hitler: The Secret Wartime Report |year=1972 |orig-date=1943 |publisher=] |location=New York |isbn=978-0-465-04620-1 |page= |title-link=The Mind of Adolf Hitler}}</ref> However, others have not drawn this conclusion; clinical forensic psychologist ] argues that Hitler's actions do not warrant a diagnosis of psychopathy as, although he showed several characteristics of criminality, he was not always egocentric, callously disregarding of feelings or lacking impulse control, and there is no proof he could not learn from mistakes.<ref>{{cite book |first=Glenn D. |last=Walters |year=2006 |chapter=Hitler the Psychopath |chapter-url=https://books.google.com/books?id=wNcshqJlms0C&pg=PA42 |title=Lifestyle Theory: Past, Present, and Future |pages=42–3 |publisher=Nova Publishers |isbn=978-1-60021-033-4 |access-date=2016-02-03 |archive-date=2017-03-23 |archive-url=https://web.archive.org/web/20170323221245/https://books.google.com/books?id=wNcshqJlms0C&pg=PA42 |url-status=live |via=]}}</ref>
===The Primary - Secondary distinction===
Primary psychopathy was defined as the root ] in patients diagnosed with it whereas secondary psychopathy was defined as an aspect of another psychiatric disorder or social circumstances.<ref name=anethopathy>{{cite journal|author=Karpman, Ben, M.D.|title=The Myth of the Psychopathic Personality|journal=The American Journal of Psychiatry|volume=104|issue=9|pages=523-534|year=1948|doi=10.1176/appi.ajp.104.9.523}}</ref> Today, primary psychopaths are considered to have mostly Factor 1 traits from the PCL-R (arrogance, callousness, manipulativeness, lying) whereas secondary psychopaths have a majority of Factor 2 traits (impulsivity, boredom proneness, irresponsibility, lack of long-term goals).<ref name=lykken/> Secondary psychopaths show normal to above-normal physiological responses to (perceived) potential threats. Their crimes tend to be unplanned and impulsive with little thought of the consequences.<ref name=mask/> They have hot tempers and are prone to reactive aggression. They experience normal to above-normal levels of anxiety but are nevertheless highly stimulus seeking and have trouble tolerating boredom. Their lifestyle may lead to depression and even suicide.


== Definition ==
Mealey uses the term "primary psychopathy" to differentiate between psychopathy that is biological in origin and "secondary psychopathy" that results from a combination of genetic and environmental influences.<ref name=mealey>Mealey, L. (1995). The sociobiology of sociopathy:An integrated evolutionary model. Behavioral and Brain Sciences, 18, 523–559.</ref> Lykken prefers sociopathy to describe the latter.
=== Concepts ===
{{Quote box|align=right|width=30em|quote=
Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and in feelings 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.
|salign=right|source=—], 1993, p. xi<ref name="Conscience"/>}}


There are multiple conceptualizations of psychopathy,<ref name="gap" /> including ''Cleckleyan psychopathy'' (]'s conception entailing bold, disinhibited behavior, and <!-- NOTE: This is not a typo. The correct word is feckless, not reckless. -->"feckless disregard") and ''criminal psychopathy'' (a meaner, more aggressive and disinhibited conception explicitly entailing persistent and sometimes serious criminal behavior). The latter conceptualization is typically used as the modern clinical concept and assessed by the Psychopathy Checklist.<ref name="gap" /> The label "psychopath" may have implications and stigma related to decisions about punishment severity for criminal acts, medical treatment, civil commitments, etc. Efforts have therefore been made to clarify the meaning of the term.<ref name="gap" />
Sellbom and Ben-Porath (2005) describe the distinction succinctly:


It has been suggested that those who share the same emotional deficiencies and psychopathic features, but are properly socialized, should not be designated as 'psychopaths'.<ref name="Yildirim, Bariş O. 2015">Yildirim, Bariş O., and Jan JL Derksen. "Clarifying the heterogeneity in psychopathic samples: Towards a new continuum of primary and secondary psychopathy." Aggression and Violent Behavior 24 (2015): 9-41.</ref>
:Some people who engage in violent behavior possess psychopathic personality traits, such as callousness, grandiosity, and fearlessness, and presumably engage in such conduct because they care little about others. Others are impulsive and experience considerable anger, anxiety, and distress and may commit violent acts as a reaction to negative emotions, which are sometimes referred to as "crimes of passion." Indeed, the distinction between primary and secondary psychopathy (including so-called neurotic psychopathy) has long been noted in the psychopathy literature (Karpman, 1947; Lykken, 1995).<ref name=sellbom>{{cite journal |author=Sellbom M, Ben-Porath YS, Lilienfeld SO, Patrick CJ, Graham JR |title=Assessing psychopathic personality traits with the MMPI-2 |journal=Journal of personality assessment |volume=85 |issue=3 |pages=334-43 |year=2005 |pmid=16318573 |doi=10.1207/s15327752jpa8503_10}}</ref>


The triarchic model<ref name="triarchic model">{{cite journal |last1=Patrick |first1=Christopher |last2=Fowles |first2=Don |last3=Krueger |first3=Robert |date=August 2009 |title=Triarchic conceptualization of psychopathy: Developmental origins of disinhibition, boldness, and meanness |journal=] |publisher=] |location=Cambridge, England |volume=21 |issue=3 |pages=913–938 |doi=10.1017/S0954579409000492 |pmid=19583890 |s2cid=6105750}}</ref> suggests that different conceptions of psychopathy emphasize three observable characteristics to various degrees. Analyses have been made with respect to the applicability of measurement tools such as the ] (PCL, PCL-R) and ] (PPI) to this model.<ref name="triarchic model"/><ref name="gap" />
This distinction closely resembles the distinction between instrumental and impulsive/reactive ]/violence in the field of ].
* '']''. Low fear including stress-tolerance, toleration of unfamiliarity and danger, and high ] and social ]. The PCL-R measures this relatively poorly and mainly through Facet 1 of Factor 1. Similar to PPI fearless dominance. May correspond to differences in the ] and other neurological systems associated with fear.<ref name="triarchic model" /><ref name="gap" />
* '']''. Poor impulse control including problems with planning and foresight, lacking affect and urge control, demand for immediate gratification, and poor behavioral restraints. Similar to PCL-R Factor 2 and PPI impulsive antisociality. May correspond to impairments in ] systems that are involved in such control.<ref name="triarchic model" /><ref name="gap" />
* '']''. Lacking empathy and close attachments with others, disdain of close attachments, use of cruelty to gain empowerment, exploitative tendencies, defiance of authority, and destructive excitement seeking. The PCL-R in general is related to this but in particular some elements in Factor 1. Similar to PPI, but also includes elements of subscales in impulsive antisociality.<ref name="triarchic model" /><ref name="gap" />


Psychopathy has been conceptualized as a hybrid condition marked by a ]ical combination of superficial charm, poise, emotional resilience, and venturesomeness on the outside but deep-seated affective disturbances and ] deficits on the inside. From this perspective, psychopathy is at least in part characterized by psychologically ].<ref>{{Cite journal |last=Blonigen |first=Daniel M. |date=2013 |title=Is fearless dominance relevant to the construct of psychopathy? Reconciling the dual roles of theory and clinical utility. |url=https://doi.apa.org/doi/10.1037/a0027152 |journal=Personality Disorders: Theory, Research, and Treatment |volume=4 |issue=1 |pages=87–88 |doi=10.1037/a0027152 |pmid=23339319 |issn=1949-2723}}</ref> Furthermore, according to this view, psychopathy may be linked to at least some interpersonally successful outcomes, such as effective leadership, business accomplishments, and heroism.<ref name="gap">{{cite journal |first1=Jennifer L. |last1=Skeem |first2=Devon L.L. |last2=Polaschek |first3=Christopher J. |last3=Patrick |first4=Scott O. |last4=Lilienfeld |title=Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy |journal=] |publisher=] |location=Thousand Oaks, California |volume=12 |issue=3 |date=December 15, 2011 |pages=95–162 |url=http://www.psychologicalscience.org/index.php/publications/journals/pspi/psychopathy.html |url-status=live |archive-url=https://web.archive.org/web/20160222023333/http://www.psychologicalscience.org/index.php/publications/journals/pspi/psychopathy.html |archive-date=February 22, 2016 |doi=10.1177/1529100611426706 |pmid=26167886 |s2cid=8521465}}</ref><ref>{{Citation |last1=Lilienfeld |first1=Scott O. |title=Fearless Dominance |date=2016 |encyclopedia=Encyclopedia of Personality and Individual Differences |pages=1–5 |editor-last=Zeigler-Hill |editor-first=Virgil |url=https://doi.org/10.1007/978-3-319-28099-8_1075-1 |access-date=2024-04-21 |place=Cham |publisher=Springer International Publishing |doi=10.1007/978-3-319-28099-8_1075-1 |isbn=978-3-319-28099-8 |last2=Watts |first2=Ashley L. |editor2-last=Shackelford |editor2-first=Todd K.}}</ref><ref>{{Cite journal |last1=Lilienfeld |first1=Scott O. |last2=Watts |first2=Ashley L. |last3=Smith |first3=Sarah Francis |date=August 2015 |title=Successful Psychopathy: A Scientific Status Report |url=https://scottlilienfeld.com/wp-content/uploads/2021/01/lilienfeld2015-2.pdf |journal=Current Directions in Psychological Science |volume=24 |issue=4 |pages=298–303 |doi=10.1177/0963721415580297 |issn=0963-7214}}</ref><ref>{{Cite book |last=Lykken |first=David T. |url=https://www.taylorfrancis.com/books/mono/10.4324/9780203763551/antisocial-personalities-david-lykken |title=The Antisocial Personalities |date=1995-05-01 |publisher=Psychology Press |isbn=978-0-203-76355-1 |location=New York |doi=10.4324/9780203763551}}</ref>
Joseph P. Newman ''et al.'' have validated David T. Lykken's conceptualization of psychopathy subtypes in relation to Gray's behavioral activation system and behavioral inhibition system.<ref name="newman_subtypes">{{cite journal |author=Newman JP, MacCoon DG, Vaughn LJ, Sadeh N |title=Validating a distinction between primary and secondary psychopathy with measures of Gray's BIS and BAS constructs |journal=Journal of abnormal psychology |volume=114 |issue=2 |pages=319-23 |year=2005 |pmid=15869363 |doi=10.1037/0021-843X.114.2.319}}</ref> Newman ''et al.'' found measures of primary psychopathy to be negatively correlated with Gray's behavioral inhibition system, a construct intended to measure behavioral inhibition from cues of punishment or nonreward.<ref name="newman_subtypes"/> In contrast, measures of secondary psychopathy to be positively correlated with Gray's behavioral activation system, a construct intended to measure sensitivity to cues of behavioral approach.<ref name="newman_subtypes"/>


=== Measurement ===
== Diagnostic criteria and PCL-R assessment ==
An early and influential analysis from Harris and colleagues indicated that a discrete category, or ], may underlie PCL-R psychopathy, allowing it to be measured and analyzed. However, this was only found for the behavioral Factor 2 items they identified, child problem behaviors; adult criminal behavior did not support the existence of a taxon.<ref>{{cite journal |doi=10.1037/0022-006X.62.2.387 |title=Psychopathy as a taxon: Evidence that psychopaths are a discrete class |year=1994 |last1=Harris |first1=Grant T. |last2=Rice |first2=Marnie E. |last3=Quinsey |first3=Vernon L. |journal=] |volume=62 |issue=2 |pages=387–97 |pmid=8201078}}</ref> Marcus, John, and Edens more recently performed a series of statistical analyses on ] scores and concluded that psychopathy may best be conceptualized as having a "dimensional latent structure" like ].<ref name="taxon">{{cite journal |doi=10.1037/0021-843X.113.4.626 |title=A Taxometric Analysis of Psychopathic Personality |date=2004 |last1=Marcus |first1=David K. |last2=John |first2=Siji L. |last3=Edens |first3=John F. |journal=] |publisher=] |location=Washington, D.C. |volume=113 |issue=4 |pages=626–35 |pmid=15535794}}</ref>
{{Main|Psychopathy Checklist-Revised (PCL-R)}}
The PCL-R has allowed for a differentiation between individuals with psychopathy and ] (APD).


Marcus ''et al.'' repeated the study on a larger sample of prisoners, using the PCL-R and seeking to rule out other experimental or statistical issues that may have produced the previously different findings.<ref>{{Cite journal |last1=Edens |first1=John F. |last2=Marcus |first2=David K. |title=Psychopathic, Not Psychopath: Taxometric Evidence for the Dimensional Structure of Psychopathy |url=https://journals.scholarsportal.info/pdf/0021843x/v115i0001/131_pnpteftdsop.xml |journal=] |publisher=]|location=Washington, D.C. |volume=115 |issue=1 |pages=131–44 |doi=10.1037/0021-843X.115.1.131 |pmid=16492104 |year=2006 |s2cid=19223010 |access-date=2019-01-22 |archive-date=2021-01-28 |archive-url=https://web.archive.org/web/20210128071126/http://pdfs.semanticscholar.org/cf88/8ecc915ca1a75eee41c1dc897068da7c0378.pdf |url-status=live}}</ref> They again found that the psychopathy measurements do not appear to be identifying a discrete type (a ]). They suggest that while for legal or other practical purposes an arbitrary cut-off point on trait scores might be used, there is actually no clear scientific evidence for an objective point of difference by which to label some people "psychopaths"; in other words, a "psychopath" may be more accurately described as someone who is "relatively psychopathic".<ref name="gap" />
In contemporary research and clinical psychiatry|clinical practice, psychopathy is most commonly assessed with the PCL-R (Hare, 1991), 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 two factors. 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). A psychopath will score high on both factors, whereas someone with APD will score high only on Factor 2.<ref>Davison, G.C., Neale, J.M., Blankstein, K.R., & Flett, G.L. (2002). ''Abnormal Psychology.'' (Etobicoke: Wiley)</ref>


The PCL-R was developed for research, not clinical forensic diagnosis, and even for research purposes to improve understanding of the underlying issues, it is necessary to examine dimensions of personality in general rather than only a constellation of traits. The PCL-R test has been used to determine "true" or primary psychopaths (individuals that score a 30 or higher on the PCL-R test). Primary psychopaths are distinguished from secondary psychopaths, and contrast with those who are legitimately considered ].<ref name="gap" /><ref>{{cite journal |first1=John F. |last1=Edens |first2=David K. |last2=Marcus |first3=Scott O. |last3=Lilienfeld |first4=Norman G. Jr. |last4=Poythress |url=http://www.antoniocasella.eu/archipsy/Edens_2006.pdf |title=Psychopathic, Not Psychopath: Taxometric Evidence for the Dimensional Structure of Psychopathy |journal=] |publisher=] |location=Washington, D.C. |volume=115 |issue=1 |date=2006 |pages=131–44 |pmid=16492104 |doi=10.1037/0021-843X.115.1.131 |s2cid=19223010 |access-date=2022-01-25 |archive-date=2020-11-23 |archive-url=https://web.archive.org/web/20201123041159/http://www.antoniocasella.eu/archipsy/Edens_2006.pdf |url-status=live}}</ref>
Both case history and a semi-structured interview are used in the analysis.


=== Personality dimensions ===
==Relationship with other mental disorders==
Studies have linked psychopathy to alternative dimensions such as antagonism (high), ] (low), and ] (low).<ref>{{cite journal |first=Karen J. |last=Derefinko |title=Psychopathy and Low Anxiety: Meta-Analytic Evidence for the Absence of Inhibition, Not Affect |journal=] |publisher=] |location=New York City |volume=83 |issue=6 |pages=693–709 |date=December 2015 |pmid=25130868 |doi=10.1111/jopy.12124}}</ref>


Psychopathy has also been linked to high ]—a theorized dimension referring to tough, aggressive, or hostile tendencies. Aspects of this that appear associated with psychopathy are lack of ] and responsibility, ], sensation-seeking (in some cases), and aggression.<ref name="handbook">{{cite book |first1=Thomas A. |last1=Widiger |first2=Donald R. |last2=Lynam |year=2002 |chapter=Psychopathy and the Five-Factor Model of Personality |pages=171–87 |editor1-first=Theodore |editor1-last=Millon |editor2-first=Erik |editor2-last=Simonsen |editor3-first=Morten |editor3-last=Birket-Smith |editor4-first=Roger D. |editor4-last=Davis |display-editors=3 |title=Psychopathy: Antisocial, Criminal, and Violent Behavior |location=New York |publisher=] |isbn=978-1-57230-864-0}}</ref><ref name="bare_url">{{cite book |first1=Marvin |last1=Zuckerman |year=1991 |title=Psychobiology of personality |publisher=] |location=Cambridge, England |page=390 |isbn=978-0-521-35942-9}}</ref><ref name="Kernberg">{{cite book |first=Kernberg |last=Otto F. |author-link=Otto F. Kernberg |title=Aggressivity, Narcissism, and Self-Destructiveness in the Psychotherapeutic Relationship: New Developments in the Psychopathology and Psychotherapy of Severe Personality Disorders |publisher=] |location=New Haven, Connecticut |date=2004 |isbn=978-0-300-10180-5 |pages=130–153}}</ref>
Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except ] disorders. Psychopathy is most strongly correlated with DSM-IV ]. PCL-R Factor 1 is correlated with ] and ]. PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality.


], from a particular ] perspective, believed psychopathy should be considered as part of a spectrum of pathological ], that would range from narcissistic personality on the low end, ] in the middle, and psychopathy at the high end.<ref name="Kernberg" />
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 ] and positive affect.


Psychopathy, narcissism, and ], three personality traits that are together referred to as the ], share certain characteristics, such as a callous-manipulative interpersonal style.<ref>{{cite journal |first1=Delroy L. |last1=Paulhus |first2=Kevin M. |last2=Williams |title=The Dark Triad of Personality |journal=] |publisher=] |location=New York City |volume=36 |issue=6 |date=December 2002 |pages=556–563 |doi=10.1016/S0092-6566(02)00505-6|s2cid=6535576 }}</ref> The ] refers to these traits with the addition of ].<ref name="RegoliHewitt2011">{{cite book |first1=Robert M. |last1=Regoli |first2=John D. |last2=Hewitt |first3=Matt |last3=DeLisi |title=Delinquency in Society: The Essentials |url=https://books.google.com/books?id=v6MTZ2WhcfIC&pg=PA99 |publisher=] |location=Burlington, Massachusetts |date=2011 |isbn=978-0-7637-7790-6 |page=99 |access-date=2016-02-03 |archive-date=2020-08-20 |archive-url=https://web.archive.org/web/20200820002434/https://books.google.com/books?id=v6MTZ2WhcfIC&pg=PA99 |url-status=live |via=]}}</ref><ref name="CampbellMiller2011">{{cite book |first1=W. Keith |last1=Campbell |first2=Joshua D. |last2=Miller |title=The Handbook of Narcissism and Narcissistic Personality Disorder: Theoretical Approaches, Empirical Findings, and Treatments |url=https://books.google.com/books?id=gw_zHSuejdcC&pg=PA154 |publisher=] |location=New York City |date=2011 |isbn=978-1-118-02924-4 |page=154 |access-date=2016-02-03 |archive-date=2020-08-19 |archive-url=https://web.archive.org/web/20200819113054/https://books.google.com/books?id=gw_zHSuejdcC&pg=PA154 |url-status=live |via=]}}</ref><ref name="LearyHoyle2009">{{cite book |first1=Mark R. |last1=Leary |first2=Rick H. |last2=Hoyle |title=Handbook of individual differences in social behavior |url=https://books.google.com/books?id=VgcGZ5sCEcIC&pg=PA100 |publisher=] |location=New York City |date=2009 |isbn=978-1-59385-647-2 |page=100 |access-date=2016-02-03 |archive-date=2021-02-25 |archive-url=https://web.archive.org/web/20210225070448/https://books.google.com/books?id=VgcGZ5sCEcIC&pg=PA100 |url-status=live |via=]}}</ref><ref>{{cite book |first1=Daniel N. |last1=Jones |first2=Delroy L. |last2=Paulhus |chapter=Differentiating the Dark Triad within the interpersonal circumplex |editor1-first=Leonard M. |editor1-last=Horowitz |editor2-first=Stephen |editor2-last=Strack |title=Handbook of interpersonal theory and research |publisher=] |location=New York City |year=2010 |isbn=978-1-118-00186-8 |pages=249–67 }}</ref><ref name="Chabrol">{{cite journal |author1=Chabrol H. |author2=Van Leeuwen N. |author3=Rodgers R. |author4=Sejourne N. |year=2009 |title=Contributions of psychopathic, narcissistic, Machiavellian, and sadistic personality traits to juvenile delinquency |journal=Personality and Individual Differences |volume=47 |issue=7 |pages=734–739 |doi=10.1016/j.paid.2009.06.020}}</ref><ref name="Buckels">{{cite journal |last1=Buckels |first1=E. E. |last2=Jones |first2=D. N. |last3=Paulhus |first3=D. L. |title=Behavioral confirmation of everyday sadism |journal=Psychological Science |volume=24 |issue=11 |pages=2201–9 |year=2013 |doi=10.1177/0956797613490749 |pmid=24022650 |s2cid=30675346}}</ref> Several psychologists have asserted that subclinical psychopathy and Machiavellianism are more or less interchangeable.<ref>Miller, Joshua D.; Hyatt, Courtland S.; Maples-Keller, Jessica L.; Carter, Nathan T.; Lynam, Donald R. (2017). "Psychopathy and Machiavellianism: A Distinction Without a Difference?". Journal of Personality. 85 (4): 439–453.</ref> There is a subscale on the Psychopathic Personality Inventory (PPI) dubbed "Machiavellian Egocentricity".<ref>Benning, S. D., Patrick, C. J., Hicks, B. M., Blonigen, D. M., & Krueger, R. F. (2003). Factor structure of the psychopathic personality inventory: validity and implications for clinical assessment. Psychological assessment, 15(3), 340.</ref><ref>Kastner, Rebecca M., Martin Sellbom, and Scott O. Lilienfeld. "A comparison of the psychometric properties of the psychopathic personality inventory full-length and short-form versions." Psychological Assessment 24, no. 1 (2012): 261.</ref> ] has asserted that the difference that most miss is that while both are characterized by manipulativeness and unemotionality, psychopaths tend to be more reckless.<ref>{{Cite journal |url=https://journals.sagepub.com/doi/abs/10.1177/1073191113514105 |title=Jones, D. N., & Paulhus, D. L. (2014). Introducing the Short Dark Triad (SD3): A Brief Measure of Dark Personality Traits. Assessment, 21(1), 28–41 |journal=Assessment |date=February 2014 |volume=21 |issue=1 |pages=28–41 |doi=10.1177/1073191113514105 |access-date=2023-09-22 |archive-date=2023-05-28 |archive-url=https://web.archive.org/web/20230528053546/https://journals.sagepub.com/doi/abs/10.1177/1073191113514105 |url-status=live |last1=Jones |first1=Daniel N. |last2=Paulhus |first2=Delroy L. |pmid=24322012 |s2cid=17524487 }}</ref> One study asserted that "the
The official stance of the ] as presented in the ] is that psychopathy and sociopathy are obsolete synonyms for antisocial personality disorder. The ] takes a similar stance in its ] by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.
ability to adapt, reappraise and reassess a situation may be key factors differentiating
Machiavellianism from psychopathy, for example".<ref>Walker, Sarah A., et al. "Primary and secondary psychopathy relate to lower cognitive reappraisal: A meta-analysis of the Dark Triad and emotion regulation processes." Personality and Individual Differences 187 (2022): 111394.</ref> Psychopathy and Machiavellianism were also correlated similarly in responses to affective stimuli, and both are negatively correlated with the recognition of facial emotions.<ref>Results indicated that primary psychopathy and Machiavellianism were positively associated with the experience of positive affect from sad stimuli, while secondary psychopathy and Machiavellianism were positively associated with the experience of negative affect in response to neutral stimuli"--- Ali, F., Amorim, I. S., & Chamorro-Premuzic, T. (2009). Empathy deficits and trait emotional intelligence in psychopathy and Machiavellianism. Personality and individual differences, 47(7), 758-762.</ref><ref>Wai, M., & Tiliopoulos, N. (2012). The affective and cognitive empathic nature of the dark triad of personality. Personality and individual differences, 52(7), 794-799.</ref> Many have suggested merging the dark triad traits (especially Machiavellianism and psychopathy) into one construct, given empirical studies that show immense overlap.<ref>Glenn, A. L., & Sellbom, M. (2015). Theoretical and empirical concerns regarding the dark triad as a construct. Journal of personality disorders, 29(3), 360-377.</ref>


=== Criticism of current conceptions ===
Among laypersons and professionals, there is much confusion about the meanings and differences between psychopathy, sociopathy, antisocial personality disorder, and ].
The current conceptions of psychopathy have been criticized for being poorly conceptualized, highly subjective, and encompassing a wide variety of underlying disorders. ] has written:


{{Blockquote|The concept and subsequent reification of the diagnosis "psychopathy" has, to this author's mind, hampered the understanding of criminality and violence. According to Hare, in many cases one need not even meet the patient. Just rummage through his records to determine what items seemed to fit. Nonsense. To this writer's mind, psychopathy and its synonyms (e.g., sociopathy and antisocial personality) are lazy diagnoses. Over the years the authors' team has seen scores of offenders who, prior to evaluation by the authors, were dismissed as psychopaths or the like. Detailed, comprehensive psychiatric, neurological, and neuropsychological evaluations have uncovered a multitude of signs, symptoms, and behaviors indicative of such disorders as ], ] spectrum disorders, complex partial seizures, ], ], and, of course, brain damage/dysfunction.<ref>{{cite book |last1=Benjamin |first1=Sadock |last2=Virginia |first2=Sadock |last3=Pedro |first3=Ruiz |title=Kaplan and Sadock's Comprehensive Textbook of Psychiatry (2 Volume Set) |isbn=978-1-4511-0047-1 |edition=10th |year=2017|publisher=Wolters Kluwer }}</ref>}}
=== Sociopathy ===
The difference between sociopathy and psychopathy, according to Hare, may "reflect the user's views on the origins and determinates of the disorder."<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 23.</ref>


Half of the Hare Psychopathy Checklist consists of symptoms of ], ], and frontal-lobe dysfunction, which frequently results in underlying disorders being dismissed.<ref>{{cite journal |last1=Lewis |first1=Dorothy |last2=Yeager |first2=Catherine |last3=Blake |first3=Pamela |last4=Bard |first4=Barbara |last5=Strenziok |first5=Maren |title=Ethics Questions Raised by the Neuropsychiatric, Neuropsychological, Educational, Developmental, and Family Characteristics of 18 Juveniles Awaiting Execution in Texas |journal=J Am Acad Psychiatry Law |date=2004 |volume=32 |issue=4 |pages=408–429 |pmid=15704627}}</ref> Hare's conception of psychopathy has also been criticized for being reductionist, dismissive, tautological, and ignorant of context as well as the dynamic nature of human behavior.<ref>{{cite journal |last1=Walters |first1=GD|title=The trouble with psychopathy as a general theory of crime. |journal=International Journal of Offender Therapy and Comparative Criminology |date=April 2004 |volume=48 |issue=2 |pages=133–48 |doi=10.1177/0306624X03259472 |pmid=15070462 |s2cid=40939723}}</ref> Some have called for rejection of the concept altogether, due to its vague, subjective and judgmental nature that makes it prone to misuse.<ref>{{cite journal |last1=Martens |first1=W.H. |title=The problem with Robert Hare's psychopathy checklist: incorrect conclusions, high risk of misuse, and lack of reliability. |journal=Medicine and Law |date=June 2008 |volume=27 |issue=2 |pages=449–62 |pmid=18693491}}</ref> A systematic review determined that the PCL is weakly predictive of criminal behavior, but not of lack of conscience, or treatment and rehabilitation outcomes. These findings contradict widespread beliefs among professionals in forensics.<ref>{{cite journal |last1=Larsen |first1=Rasmus Rosenberg |last2=Jalava |first2=Jarkko |last3=Griffiths |first3=Stephanie |title=Are Psychopathy Checklist (PCL) psychopaths dangerous, untreatable, and without conscience? A systematic review of the empirical evidence. |journal=Psychology, Public Policy, and Law |date=August 2020 |volume=26 |issue=3 |pages=297–311 |doi=10.1037/law0000239|s2cid=219505223 }}</ref>
] proposes that psychopathy and sociopathy are two distinct kinds of ]. He holds that psychopaths are born with temperamental differences such as impulsivity, cortical underarousal, and fearlessness that lead them to risk-seeking behavior and an inability to internalize ]; sociopaths, on the other hand, have relatively normal temperaments; their personality disorder being more an effect of negative sociological factors like parental neglect, delinquent peers, ], and extremely low or extremely high intelligence. Both personality disorders are, of course, the result of an interaction between genetic predispositions and environmental factors, but psychopathy leans towards the hereditary whereas sociopathy tends towards the environmental.<ref name=lykken>Lykken, David T. ''The Antisocial Personalities'' (1995).</ref>


Psychopathic individuals do not show ] or ]. This was thought to be due to an inability to generate this emotion in response to negative outcomes. However, in 2016, people with ] were found to experience regret but did not use the regret to guide their choice in behavior. There was no lack of regret but a problem to think through a range of potential actions and estimating the outcome values.<ref>{{cite journal |pmid=27911790 |doi=10.1073/pnas.1609985113 |volume=113 |issue=50 |title=Psychopathic individuals exhibit but do not avoid regret during counterfactual decision making |pmc=5167137 |year=2016 |journal=Proceedings of the National Academy of Sciences of the USA |pages=14438–14443 |last1=Baskin-Sommers |first1=A |last2=Stuppy-Sullivan |first2=AM |last3=Buckholtz |first3=JW |bibcode=2016PNAS..11314438B |doi-access=free}}</ref>
=== Antisocial personality disorder ===
{{main|Antisocial personality disorder}}
Comparing psychopathy to antisocial personality disorder is a continuing source of debate within the psychological community. The official stance of the ] as presented in the ] is that psychopathy and sociopathy are obsolete synonyms for ] (APD).{{Verify source|date=August 2007}} The ] takes a similar stance in its ] by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.


In an experiment published in March 2007 at the ] neuroscientist ] and his colleagues showed that subjects with damage to the ] lack the ability to empathically feel their way to moral answers, and that when confronted with moral dilemmas, these brain-damaged patients coldly came up with "end-justifies-the-means" answers, leading Damasio to conclude that the point was not that they reached immoral conclusions, but that when they were confronted by a difficult issue – in this case as whether to shoot down a passenger plane hijacked by terrorists before it hits a major city – these patients appear to reach decisions without the anguish that afflicts those with typically functioning brains. According to ], a clinical neuroscientist also at the University of Southern California, one of this study's implications is that society may have to rethink how it judges immoral people: "Psychopaths often feel no empathy or remorse. Without that awareness, people relying exclusively on reasoning seem to find it harder to sort their way through moral thickets. Does that mean they should be held to different standards of accountability?"<ref name="brain">{{cite news
Hare and others take the stance that psychopathy as a syndrome should be considered distinct from the DSM-IV's antisocial personality disorder construct,<ref>Hare, R. D. Accessed ], ]</ref> even though APD and psychopathy were intended to be equivalent in the DSM-IV. However, those who created the DSM-IV felt that there was too much room for ] on the part of ] when identifying things like remorse and guilt; therefore, the DSM-IV panel decided to stick to observable behaviour, namely socially ] behaviours. As a result, the diagnosis of APD is something that the "majority of criminals easily meet."<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 25.</ref> Hare goes further to say that the percentage of incarcerated criminals that meet the requirements of APD is somewhere between 80 to 85 percent, whereas only about 20% of these criminals would qualify for a diagnosis of psychopath. This twenty percent, according to Hare, accounts for 50 percent of all the most serious crimes committed, including half of all serial and repeat ]. According to ] reports, 44 percent of all police officer murders in 1992 were committed by psychopaths.<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 25-30.</ref>
|url=https://www.washingtonpost.com/wp-dyn/content/article/2007/05/27/AR2007052701056.html
|title=If It Feels Good to Be Good, It Might Be Only Natural
|newspaper=The Washington Post
|date=28 May 2007
|first=Shankar
|last=Vedantam
|access-date=23 April 2010}}</ref>


== Cause ==
One study found that only 20 percent of those diagnosed with APD qualified as psychopath on the PCL-R.<ref>{{cite journal |author=Rutherford MJ, Cacciola JS, Alterman AI |title=Antisocial personality disorder and psychopathy in cocaine-dependent women |journal=The American Journal of Psychiatry |volume=156 |issue=6 |pages=849-56 |year=1999 |pmid=10360122 |doi=}}</ref>
] studies have identified potential genetic and non-genetic contributors to psychopathy, including influences on brain function. Proponents of the triarchic model believe that psychopathy results from the interaction of genetic predispositions and an adverse environment. What is adverse may differ depending on the underlying predisposition: for example, it is hypothesized that persons having high boldness may respond poorly to punishment but may respond better to rewards and secure attachments.<ref name="triarchic model" /><ref name="gap" />


=== Genetic ===
Another study using the PCL-R to examine the relationship between antisocial behaviour and ] found that suicide history was strongly correlated to PCL-R Factor 2 (reflecting antisocial deviance) and was not correlated to PCL-R factor 1 (reflecting affective functioning). Given that APD relates to Factor 2, whereas psychopathy relates to both factors, this would confirm Hervey Cleckley's assertion that psychopaths are relatively immune to suicide. People with APD, on the other hand, have a relatively high suicide rate.<ref>{{cite journal |author=Verona E, Patrick CJ, Joiner TE |title=Psychopathy, antisocial personality, and suicide risk |journal=Journal of Abnormal Psychology |volume=110 |issue=3 |pages=462-70 |year=2001 |pmid=11502089 |doi=}}</ref>
] studies of the personality characteristics typical of individuals with psychopathy have found moderate genetic (as well as non-genetic) influences. On the PPI, fearless dominance and impulsive antisociality were similarly influenced by genetic factors and uncorrelated with each other. Genetic factors may generally influence the development of psychopathy while environmental factors affect the specific expression of the traits that predominate. A study on a large group of children found more than 60% heritability for "]" and that conduct disorder among children with these traits has a higher heritability than among children without these traits.<ref name="gap" /><ref name="HareNeumann2008" /><ref name="Glenn2011" />


=== Environment ===
===Pseudopsychopathic personality disorder===
], it is known that the ] plays an important role in moral behavior.]]
It has been suggested that people can suffer apparently psychopathic personality changes from ]s or damage of the brain's ].<ref> Crimelibrary.com</ref><ref>, ''Salon.com''</ref> This is sometimes called ] or ].


A study by Farrington of a sample of London males between ages 8 and 48 included studying which factors scored 10 or more on the PCL:SV at age 48. The strongest factors included having a convicted parent, being physically neglected, low involvement of the father with the boy, low family income, and coming from a disrupted family. Other significant factors included poor supervision, abuse, harsh discipline, large family size, delinquent siblings, young mothers, depressed mothers, low social class, and poor housing.<ref name=Patrick2005b>{{cite book |editor1-last=Patrick |editor1-first=Christopher J |year=2005 |title=Handbook of Psychopathy |publisher=Guilford Press |pages=234, 240}}</ref> There has also been an association between psychopathy and detrimental treatment by peers.<ref name="Without Conscience">{{cite book |last=Hare |first=Robert D. |author-link=Robert D. Hare |title=Without Conscience: The Disturbing World of the Psychopaths Among Us |publisher=Guilford Press |location=New York |year=1999 |isbn=978-1-57230-451-2 |url=https://archive.org/details/withoutconscienc00hare }}{{page needed|date=September 2013}}</ref> However, it is difficult to determine the extent of an environmental influence on the development of psychopathy because of evidence of its strong heritability.<ref>{{cite web|last1=Wallisch|first1=Pascal|title=Psychopaths in our midst — what you should know|url=https://www.elsevier.com/connect/psychopaths-what-are-they-and-how-should-we-deal-with-them|website=Elsevier Connect|publisher=Elsevier B.V.|access-date=10 April 2016|date=November 17, 2014|url-status=live|archive-url=https://web.archive.org/web/20160423203039/https://www.elsevier.com/connect/psychopaths-what-are-they-and-how-should-we-deal-with-them|archive-date=23 April 2016}}</ref>
One well-known and dramatic case was that of ], a ] railroad work supervisor, who had been relatively mild-tempered before the damage to his brain occurred. According to ], 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. Accessed ], ]</ref>


==== Brain injury ====
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). Computerized reconstructions of the possible ] suggest that, from his known injuries he seemed likely to have had a lesion on the ventromedial frontal cortex.
Researchers have linked ] with psychopathy and violence. Since the 1980s, scientists have associated ], such as damage to the ], including the ], with psychopathic behavior and a deficient ability to make morally and socially acceptable decisions, a condition that has been termed "acquired sociopathy", or "pseudopsychopathy".<ref name="Kiehl2006" /> Individuals with damage to the area of the prefrontal cortex known as the ] show remarkable similarities to diagnosed psychopathic individuals, displaying reduced ] to emotional stimuli, deficits in aversive conditioning, similar preferences in moral and economic decision making, and diminished empathy and social emotions like guilt or shame.<ref>{{cite journal |last1=Koenigs |first1=Michael |title=The role of prefrontal cortex in psychopathy. |journal=] |date=2012 |volume=23 |issue=3 |pages=253–62 |doi=10.1515/revneuro-2012-0036 |pmid=22752782 |pmc=3937069}}</ref> These emotional and moral impairments may be especially severe when the brain injury occurs at a young age. Children with early damage in the prefrontal cortex may never fully develop social or moral reasoning and become "psychopathic individuals&nbsp;... characterized by high levels of aggression and antisocial behavior performed without guilt or empathy for their victims". Additionally, damage to the ] may impair the ability of the prefrontal cortex to interpret feedback from the ], which could result in uninhibited signals that manifest in violent and aggressive behavior.<ref name="Protect – Watch Your Head">{{cite web |url=http://www.fi.edu/learn/brain/head.html |title=Protect – Watch Your Head |year=2004 |website=The Franklin Institute Online |publisher=The Franklin Institute |access-date=July 10, 2013 |archive-url=https://web.archive.org/web/20130708224943/http://www.fi.edu/learn/brain/head.html |archive-date=July 8, 2013 }}</ref><ref name=Blair2002/>


==== Childhood trauma ====
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 ] physicians who examined him intensively in ]. No police records or newspaper accounts can be found for Gage's alleged drunken behavior or violence, nor any record of his mother complaining to Dr. Harlow, despite being in contact for years.
{{excerpt|Influence of childhood trauma in psychopathy}}


=== Other theories ===
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 ], eventually succumbing to ] 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 ] and manage a Concord stagecoach, a difficult cognitive-motor task, which he apparently mastered.


==== Evolutionary explanations ====
==Childhood precursors==
{{see also|Evolutionary psychiatry}}
Psychopathy is associated with several adverse life outcomes as well as an increased risk of disability and death due to factors such as violence, accidents, homicides, and suicides. This, in combination with the evidence for genetic influences, is evolutionarily puzzling and may suggest that there are compensating evolutionary advantages, and researchers within ] have proposed several evolutionary explanations. According to one hypothesis, some traits associated with psychopathy may be socially adaptive, and psychopathy may be a frequency-dependent, socially ] strategy, which may work as long as there is a large population of ] and ] individuals, relative to the population of psychopathic individuals, to be exploited.<ref name="Glenn2011">{{cite journal |doi=10.1016/j.avb.2011.03.009 |title=Evolutionary theory and psychopathy |year=2011 |last1=Glenn |first1=Andrea L. |last2=Kurzban |first2=Robert |last3=Raine |first3=Adrian |journal=Aggression and Violent Behavior |volume=16 |issue=5 |pages=371–380}}</ref><ref name="Sorman2015">{{cite book |last1=Sörman |first1=Karolina |title=The Psychopathy Construct in a Swedish Context - Conceptualization and Validation of Different Assessments |date=2015 |publisher=] |location=Stockholm |isbn=978-91-7549-910-9 |page=29 |url=http://evolution.binghamton.edu/dswilson/wp-content/uploads/2010/01/DSW14.pdf |access-date=27 April 2016 |archive-url=https://web.archive.org/web/20150415084544/http://evolution.binghamton.edu/dswilson/wp-content/uploads/2010/01/DSW14.pdf |archive-date=15 April 2015}}</ref> It is also suggested that some traits associated with psychopathy such as early, promiscuous, adulterous, and coercive sexuality may increase reproductive success.<ref name="Glenn2011" /><ref name="Sorman2015" /><ref>{{Cite news |last=Manis |first=Emily |date=2022-09-13 |title=Psychopathic men have an extreme focus on mating at the expense of other domains and tend to be "parasitic" fathers |url=https://www.psypost.org/2022/09/psychopathic-men-have-an-extreme-focus-on-mating-at-the-expense-of-other-domains-and-tend-be-parasitic-fathers-63664 |access-date=2022-09-27 |newspaper=Psypost - Psychology News |archive-date=2022-09-27 |archive-url=https://web.archive.org/web/20220927080606/https://www.psypost.org/2022/09/psychopathic-men-have-an-extreme-focus-on-mating-at-the-expense-of-other-domains-and-tend-be-parasitic-fathers-63664 |url-status=live }}</ref> Robert Hare has stated that many psychopathic males have a pattern of mating with and quickly abandoning women, and thereby have a high ] rate, resulting in children that may inherit a predisposition to psychopathy.<ref name="gap" /><ref name="Without Conscience" /><ref>{{cite journal |doi=10.1111/j.1745-6924.2009.01138.x |pmid=26158983 |title=How Can Evolutionary Psychology Successfully Explain Personality and Individual Differences? |year=2009 |last1=Buss |first1=David M. |journal=Perspectives on Psychological Science |volume=4 |issue=4 |pages=359–66 |s2cid=2565416}}</ref>


Criticism includes that it may be better to look at the contributing personality factors rather than treat psychopathy as a unitary concept due to poor testability. Furthermore, if psychopathy is caused by the combined effects of a very large number of adverse mutations then each mutation may have such a small effect that it escapes natural selection.<ref name="gap" /><ref name="Glenn2011" /> The personality is thought to be influenced by a very large number of genes and may be disrupted by random mutations, and psychopathy may instead be a product of a high ].<ref name="Glenn2011" /> Psychopathy has alternatively been suggested to be a ], a byproduct, or side-effect, of the evolution of adaptive traits rather than an adaptation in itself.<ref name="Sorman2015" /><ref>{{cite journal |last1=Leedom |first1=Liane J. |last2=Almas |first2=Linda Hartoonian |title=Is psychopathy a disorder or an adaptation? |journal=] |date=December 2012 |volume=3 |pages=549 |doi=10.3389/fpsyg.2012.00549 |pmid=23424583 |pmc=3573869 |doi-access=free}}</ref>
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 ]. 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. Conduct disorder, as well as its subcategory ], can sometimes develop into adult psychopathy. However, conduct disorder "fails to capture the emotional, cognitive and interpersonality traits - egocentricity, lack of remorse, empathy or guilt - that are so important in the diagnosis of psychopathy."<ref>Hare, Robert D. ''Without Conscience: The Disturbing World of Psychopaths Among Us,'' (New York: Pocket Books, 1993) pg 159.</ref>


== Mechanisms ==
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, </ref>


=== Psychological ===
The following childhood indicators are to be interpreted not as to the type of behavior, but as to its relentless and unvarying occurrence. Not all must be present concurrently, but at least a number of them need to be present over a period of years:
{{see also|#Mental characteristics}}
Some laboratory research demonstrates correlations between psychopathy and atypical responses to aversive stimuli, including weak ] to painful stimuli and poor learning of avoiding responses that cause ], as well as low reactivity in the ] as measured with ] while waiting for a painful stimulus but not when the stimulus occurs. While it has been argued that the ] functions normally, some studies have also found reduced reactivity to pleasurable stimuli. According to the ], psychopathic individuals have also had difficulty switching from an ongoing action despite environmental cues signaling a need to do so.<ref name="SmithLilienfeld2015">{{cite journal |last1=Smith |first1=Sarah Francis |last2=Lilienfeld |first2=Scott O. |title=The response modulation hypothesis of psychopathy: A meta-analytic and narrative analysis. |journal=] |volume=141 |issue=6 |year=2015 |pages=1145–1177 |issn=1939-1455 |doi=10.1037/bul0000024 |pmid=26302165 |s2cid=19644741}}</ref> This may explain the difficulty responding to punishment, although it is unclear if it can explain findings such as deficient conditioning. There may be methodological issues regarding the research.<ref name="gap" /> While establishing a range of idiosyncrasies on average in linguistic and affective processing under certain conditions, this research program has not confirmed a common pathology of psychopathy.<ref>Patrick, Christopher J. (Editor) {{Webarchive|url=https://web.archive.org/web/20170403231750/https://books.google.com/books?id=OuNdrmHcJlgC&q=nato#v=snippet |date=2017-04-03 }} (2005). Chapter 3: Other Theoretical Models of Psychopathy, Ronald Blackburn, Page 39</ref>
:* An extended period of ] past the preschool years that is not due to any medical problem.
:* ] beyond an angry outburst.
:* ] and other vandalism. Not to be confused with playing with matches, which is not uncommon for preschoolers. This is the deliberate setting of destructive fires with utter disregard for the property and lives of others.
:* Lying, often without discernible objectives, extending beyond a child's normal impulse not to be punished. Lies that are so extensive that it is often impossible to know lies from truth.
:* Theft and truancy.
:* Aggression to peers, not necessarily physical, which can include getting others into trouble or a campaign of psychological torment.


=== Neurological ===
The three indicators&mdash;], ] and ], known as the ]&mdash;were first described by J.M. MacDonald as indicators of psychopathy.<ref name=macdonald>{{cite journal|author=J. M. MacDonald|title=The Threat to Kill|journal=American Journal of Psychiatry|volume=120|issue=2|pages=125-130|year=1963}}</ref> Though the relevance of these indicators to ] ] has since been called into question, they are considered relevant to psychopathy.
], among other areas, is implicated in the mechanism of psychopathy.]]
Thanks to advancing ] studies, experts can visualize specific brain differences and abnormalities of individuals with psychopathy in areas that control emotions, social interactions, ethics, morality, regret, impulsivity, and conscience within the brain. Blair, a researcher who pioneered research into psychopathic tendencies stated, "With regard to psychopathy, we have clear indications regarding why the pathology gives rise to the emotional and behavioral disturbance and important insights into the neural systems implicated in this pathology".<ref name=Blair2002 /> Dadds et al., remarks that despite a rapidly advancing neuroscience of empathy, little is known about the developmental underpinnings of the psychopathic disconnect between affective and cognitive empathy.<ref name="Dadds et al.">{{cite journal |title=Learning to 'talk the talk': the relationship of psychopathic traits to deficits in empathy across childhood |year=2010 |last=Dadds |first=Mark |journal=The Journal of Child Psychology and Psychiatry |volume=50 |pages=599–606 |issue=5 |doi=10.1111/j.1469-7610.2008.02058.x|pmid=19445007 |display-authors=etal}}</ref>


A 2008 review by Weber et al. suggested that psychopathy is sometimes associated with brain abnormalities in ]-]-] regions that are involved in emotional and learning processes, among others.<ref name="review2008">{{cite journal |doi=10.1002/bsl.802 |title=Structural brain abnormalities in psychopaths—a review |year=2008 |last1=Weber |first1=Sabrina |last2=Habel |first2=Ute |last3=Amunts |first3=Katrin |last4=Schneider |first4=Frank |journal=] |volume=26 |pages=7–28 |pmid=18327824 |issue=1}}</ref> Neuroimaging studies have found structural and functional differences between those scoring high and low on the PCL-R in a 2011 review by Skeem et al. stating that they are "most notably in the ], ] and ], anterior and posterior ], ], ], and ] and ] ]".<ref name="gap" /><ref>{{Cite journal |pmc=2784035 |year=2009 |last1=Yang |first1=Y. |title=Prefrontal Structural and Functional Brain Imaging findings in Antisocial, Violent, and Psychopathic Individuals: A Meta-Analysis |journal=Psychiatry Research |volume=174 |issue=2 |pages=81–88 |last2=Raine |first2=A. |pmid=19833485 |doi=10.1016/j.pscychresns.2009.03.012}}</ref>
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>{{cite journal |author=Hawes DJ, Dadds MR |title=The treatment of conduct problems in children with callous-unemotional traits |journal=Journal of Consulting and Clinical Psychology |volume=73 |issue=4 |pages=737-41 |year=2005 |pmid=16173862 |doi=10.1037/0022-006X.73.4.737}}</ref>


The amygdala and frontal areas have been suggested as particularly important.<ref name="pmid18434283">{{cite journal |doi=10.1098/rstb.2008.0027 |title=The amygdala and ventromedial prefrontal cortex: Functional contributions and dysfunction in psychopathy |year=2008 |last1=Blair |first1=R.J.R |journal=Philosophical Transactions of the Royal Society B: Biological Sciences |volume=363 |issue=1503 |pages=2557–65 |pmid=18434283 |pmc=2606709}}</ref> People scoring 25 or higher in the PCL-R, with an associated history of violent behavior, appear on average to have significantly reduced microstructural integrity between the ] connecting the amygdala and ] (such as the uncinate fasciculus). The evidence suggested that the degree of abnormality was significantly related to the degree of psychopathy and may explain the offending behaviors.<ref name="pmid19506560"/> Furthermore, changes in the amygdala have been associated with "callous-unemotional" traits in children. However, the amygdala has also been associated with positive emotions, and there have been inconsistent results in the studies in particular areas, which may be due to methodological issues.<ref name="gap" /> Others have cast doubt on the amygdala as important for psychopathy, with one meta-analysis suggesting that most studies on the amygdala and psychopathy find ] and that studies finding a negative effect (that psychopaths display less amygdala activity) have lower ].<ref name="p985">{{cite journal | last1=Deming | first1=Philip | last2=Heilicher | first2=Mickela | last3=Koenigs | first3=Michael | title=How reliable are amygdala findings in psychopathy? A systematic review of MRI studies | journal=Neuroscience & Biobehavioral Reviews | publisher=Elsevier BV | volume=142 | year=2022 | issn=0149-7634 | doi=10.1016/j.neubiorev.2022.104875 | page=104875| pmid=36116578 }}</ref>
== Discrete taxon vs. continuous dimension ==
As part of the larger debate on whether personality disorders are distinct from normal personality or extremes on various dimensions of normal personality is the debate on whether psychopathy represents something "qualitatively different" from normal personality or a "continuous dimension" shading from normality into severely psychopathic. Early taxonometric analysis from Harris and colleagues<ref>{{cite journal |author=Harris GT, Rice ME, Quinsey VL |title=Psychopathy as a taxon: evidence that psychopaths are a discrete class |journal=Journal of Consulting and Clinical Psychology |volume=62 |issue=2 |pages=387-97 |year=1994 |pmid=8201078 |doi=}}</ref> indicated that a discrete category may underlie psychopathy, however this was only found for the behavioural Factor 2 items, indicating that this analysis may be related to Anti-social Personality Disorder rather than psychopathy per se. John Marcus, and Edens more recently performed a series of statistical analysis on previously attained PCL–R and PPI scores and concluded that psychopathy may best be conceptualized as having a "dimensional latent structure" like ].<ref name="taxon">{{cite journal |author=Marcus DK, John SL, Edens JF |title=A taxometric analysis of psychopathic personality |journal=Journal of Abnormal Psychology |volume=113 |issue=4 |pages=626-35 |year=2004 |pmid=15535794 |doi=10.1037/0021-843X.113.4.626}}</ref>


Some of these findings are consistent with other research and theories. For example, in a ] study of how individuals with psychopathy respond to emotional words, widespread differences in activation patterns have been shown across the temporal lobe when psychopathic criminals were compared to "normal" volunteers, which is consistent with views in clinical psychology. Additionally, the notion of psychopathy being characterized by low fear is consistent with findings of abnormalities in the amygdala, since deficits in aversive conditioning and instrumental learning are thought to result from amygdala dysfunction, potentially compounded by ] dysfunction, although the specific reasons are unknown.<ref name=Blair2002>{{cite journal |doi=10.1192/bjp.182.1.5 |title=Neurobiological basis of psychopathy |year=2003 |last1=Blair |first1=R. J. R. |journal=The British Journal of Psychiatry |volume=182 |pages=5–7 |pmid=12509310 |issue=1|doi-access=free }}</ref><ref>{{cite journal |doi=10.1111/j.1440-1614.2005.01679.x |title=Neuroimaging in psychopathy |year=2005 |last1=Pridmore |first1=Saxby |last2=Chambers |first2=Amber |last3=McArthur |first3=Milford |journal=Australian and New Zealand Journal of Psychiatry |volume=39 |issue=10 |pages=856–65 |pmid=16168013}}</ref>
In contrast, the PCL–R sets a score of 30 out of 40 for ]n male inmates as its cut-off point for a diagnosis of psychopathy, however this is an abitrary cut-off and should not be taken to reflect any sort of underlying structure for the disorder.


Considerable research has documented the presence of the two subtypes of primary and secondary psychopathy.<ref name="Patrick2018">Patrick, C. J. (2018). ''Cognitive and emotional processing in psychopathy''. In C. J. Patrick (Ed.), ''Handbook of psychopathy'' 2nd edition (ch. 18, pp. 422–455). The Guilford Press.</ref><ref name="Hicks2018">Hicks, B. M., & Drislane, L. E. (2018). ''Variants ("subtypes") of psychopathy''. In C. J. Patrick (Ed.), ''Handbook of psychopathy'' 2nd edition (ch. 13, pp. 297–332). The Guilford Press.</ref> Proponents of the primary-secondary psychopathy distinction and triarchic model argue that there are neurological differences between these subgroups of psychopathy which support their views.<ref>{{Cite journal |last=Sophia |first=Wellons |date=2012 |title=The Devil in the Boardroom: Corporate Psychopaths and Their Impact on Business |url=https://digitalcommons.wou.edu/pure/vol1/iss1/9/ |journal=PURE Insights |volume=1 |issue=1 |url-status=live |archive-url=https://web.archive.org/web/20180216204329/https://digitalcommons.wou.edu/pure/vol1/iss1/9/ |archive-date=2018-02-16}}</ref> For instance, the boldness factor in the triarchic model is argued to be associated with reduced activity in the amygdala during fearful or aversive stimuli and reduced ], while the disinhibition factor is argued to be associated with impairment of frontal lobe tasks. There is evidence that boldness and disinhibition are genetically distinguishable.<ref name="gap" />
== Perceptual/emotional recognition deficits ==
In a 2002 study, David Kosson and Yana Suchy, ''et al.'' asked psychopathic inmates to name the emotion expressed on each of 30 faces; compared to controls, psychopaths had a significantly lower rate of accuracy in recognizing disgusted facial affect but a higher rate of accuracy in recognizing anger. Additionally, when "conditions designed to minimize the involvement of left-hemispheric mechanisms" were used, psychopaths had more difficulty accurately identifying emotions. This study did not replicate Blaire, ''et al.'' (1997)'s findings that psychopaths are specifically less sensitive to nonverbal cues of fear or distress.<ref name="kosson">{{cite journal |author=Kosson DS, Suchy Y, Mayer AR, Libby J |title=Facial affect recognition in criminal psychopaths |journal=Emotion (Washington, D.C.) |volume=2 |issue=4 |pages=398-411 |year=2002 |pmid=12899372 |doi=}}</ref>


=== Biochemical ===
In a 2002 experiment, Mitchell Blair ''et al.'' used the Vocal Affect Recognition Test to measure psychopaths' recognition of the emotional intonation given to connotatively neutral words. Psychopaths tended to make more recognition errors than controls with a particularly high rate of error for sad and fearful vocal affect.<ref name="blair">{{cite journal |author=Blair RJ, Mitchell DG, Richell RA, ''et al'' |title=Turning a deaf ear to fear: impaired recognition of vocal affect in psychopathic individuals |journal=Journal of Abnormal Psychology |volume=111 |issue=4 |pages=682-6 |year=2002 |pmid=12428783 |doi=}}</ref>
High levels of ] combined with low levels of ] and/or ] have been theorized as contributing factors. Testosterone is "associated with approach-related behavior, reward sensitivity, and fear reduction", and injecting testosterone "shift the balance from punishment to reward sensitivity", decreases fearfulness, and increases "responding to angry faces". Some studies have found that high testosterone levels are associated with antisocial and aggressive behaviors, yet other research suggests that testosterone alone does not cause aggression but increases dominance-seeking. It is unclear from studies if psychopathy correlates with high testosterone levels, but a few studies have found that disruption of serotonin neurotransmission disrupts cortisol reactivity to a stress-inducing speech task. Thus, dysregulation of serotonin in the brain may contribute to the low cortisol levels observed in psychopathy. Cortisol increases withdrawal behavior and sensitivity to punishment and aversive conditioning, which are abnormally low in individuals with psychopathy and may underlie their impaired aversion learning and disinhibited behavior. High testosterone levels combined with low serotonin levels are associated with "impulsive and highly negative reactions", and may increase violent aggression when an individual is provoked or becomes frustrated.<ref name=Glenn2008>{{cite journal |doi=10.1016/j.psc.2008.03.004 |title=The Neurobiology of Psychopathy |year=2008 |last1=Glenn |first1=Andrea L. |last2=Raine |first2=Adrian |journal=Psychiatric Clinics of North America |volume=31 |issue=3 |pages=463–75, vii |pmid=18638646}}</ref> Several animal studies note the role of ] functioning in impulsive aggression and antisocial behavior.<ref>{{cite journal |doi=10.1017/S0954579409000418 |title=Multifinality in the development of personality disorders: A Biology × Sex × Environment interaction model of antisocial and borderline traits |year=2009 |last1=Beauchaine |first1=Theodore P. |last2=Klein |first2=Daniel N. |last3=Crowell |first3=Sheila E. |last4=Derbidge |first4=Christina |last5=Gatzke-Kopp |first5=Lisa |journal=Development and Psychopathology |volume=21 |issue=3 |pages=735–70 |pmid=19583882 |pmc=2709751}}</ref><ref>{{cite journal |doi=10.1017/S0954579405050546 |title=Developmental psychopathology and neurobiology of aggression |year=2005 |last1=Gollan |first1=Jackie K. |last2=Lee |first2=Royce |last3=Coccaro |first3=Emil F. |journal=Development and Psychopathology |volume=17 |issue=4 |pages=1151–71 |doi-broken-date=1 November 2024 |pmid=16613435 |s2cid=40617060}}</ref><ref>{{cite book |vauthors=Lee R, Coccaro ER |chapter=Neurobiology of impulsive aggression: Focus on serotonin and the orbitofrontal cortex |veditors=Flannery DJ, Vazsonyi AT, Waldman ID |title=The Cambridge handbook of violent behavior and aggression |location=New York |publisher=] |year=2007 |pages=170–86 |isbn=978-0-521-60785-8}}</ref><ref>{{cite journal |doi=10.1037/0033-2909.133.1.149 |title=The evidence for a neurobiological model of childhood antisocial behavior |year=2007 |last1=Van Goozen |first1=Stephanie H. M. |last2=Fairchild |first2=Graeme |last3=Snoek |first3=Heddeke |last4=Harold |first4=Gordon T. |journal=] |volume=133 |pages=149–82 |pmid=17201574 |issue=1 |citeseerx=10.1.1.326.8003}}</ref>


However, some studies on animal and human subjects have suggested that the emotional-interpersonal traits and predatory aggression of psychopathy, in contrast to impulsive and reactive aggression, is related to ''increased'' ]ergic functioning.<ref name="GlennJanuary2011">{{cite journal |last1=Glenn |first1=Andrea L. |title=The other allele: Exploring the long allele of the serotonin transporter gene as a potential risk factor for psychopathy: A review of the parallels in findings |journal=] |date=January 2011 |volume=35 |issue=3 |pages=612–620 |doi=10.1016/j.neubiorev.2010.07.005 |pmc=3006062 |pmid=20674598}}</ref><ref>{{cite journal |last1=van de Giessen |first1=Elsmarieke |last2=Rosell |first2=Daniel R. |last3=Thompson |first3=Judy L. |last4=Xu |first4=Xiaoyan |last5=Girgis |first5=Ragy R. |last6=Ehrlich |first6=Yosefa |last7=Slifstein |first7=Mark |last8=Abi-Dargham |first8=Anissa |last9=Siever |first9=Larry J. |title=Serotonin transporter availability in impulsive aggressive personality disordered patients: A PET study with DASB |journal=] |date=November 2014 |volume=58 |pages=147–154 |doi=10.1016/j.jpsychires.2014.07.025 |pmid=25145808}}</ref><ref>{{cite journal |last1=Line |first1=Samantha J. |last2=Barkus |first2=Chris |last3=Rawlings |first3=Nancy |last4=Jennings |first4=Katie |last5=McHugh |first5=Stephen |last6=Sharp |first6=Trevor |last7=Bannerman |first7=David M. |title=Reduced sensitivity to both positive and negative reinforcement in mice over-expressing the 5-hydroxytryptamine transporter |journal=] |date=December 2014 |volume=40 |issue=12 |pages=3735–3745 |doi=10.1111/ejn.12744 |pmid=25283165 |pmc=4737229}}</ref><ref>{{cite journal |last1=Dunlop |first1=Boadie W. |last2=DeFife |first2=Jared A. |last3=Marx |first3=Lauren |last4=Garlow |first4=Steven J. |last5=Nemeroff |first5=Charles B. |last6=Lilienfeld |first6=Scott O. |title=The Effects of Sertraline on Psychopathic Traits |journal=International Clinical Psychopharmacology |date=1 November 2011 |volume=26 |issue=6 |pages=329–337 |doi=10.1097/YIC.0b013e32834b80df |pmid=21909028 |pmc=3202964 |issn=0268-1315}}</ref> A study by Dolan and Anderson, regarding the relationship between serotonin and psychopathic traits in a sample of personality disordered offenders, found that serotonin functioning as measured by ] response, while inversely associated with impulsive and antisocial traits, were positively correlated with arrogant and deceitful traits, and, to a lesser extent, callous and remorseless traits.<ref>{{cite journal |last1=Dolan |first1=Mairead C. |last2=Anderson |first2=Ian M. |title=The relationship between serotonergic function and the Psychopathy Checklist: Screening Version |journal=] |date=1 June 2003 |volume=17 |issue=2 |pages=216–222 |pmid=12870570 |issn=0269-8811 |doi=10.1177/0269881103017002011 |s2cid=13239172}}</ref> Bariş Yildirim theorizes that the ] "long" allele, which is generally regarded as protective against ]s, may interact with other serotoninergic genes to create a hyper-regulation and dampening of affective processes that results in psychopathy's emotional impairments.<ref name="Yildirim2013">{{cite journal |last1=Yildirim |first1=Bariş O. |title=Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy |journal=] |date=August 2013 |volume=37 |issue=7 |pages=1254–1296 |doi=10.1016/j.neubiorev.2013.04.009 |pmid=23644029 |s2cid=19350747 |url=https://www.researchgate.net/publication/236638079 |access-date=7 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20161006143502/https://www.researchgate.net/publication/236638079_Systematic_review_structural_analysis_and_new_theoretical_perspectives_on_the_role_of_serotonin_and_associated_genes_in_the_etiology_of_psychopathy_and_sociopathy |archive-date=6 October 2016}}</ref> Furthermore, the combination of the 5-HTTLPR long allele and high testosterone levels has been found to result in a reduced response to threat as measured by cortisol reactivity, which mirrors the fear deficits found in those with psychopathy.<ref>{{cite journal |last1=Josephs |first1=Robert A. |last2=Telch |first2=Michael J. |last3=Hixon |first3=J. Gregory |last4=Evans |first4=Jacqueline J. |last5=Lee |first5=Hanjoo |last6=Knopik |first6=Valerie S. |last7=McGeary |first7=John E. |last8=Hariri |first8=Ahmad R. |last9=Beevers |first9=Christopher G. |title=Genetic and hormonal sensitivity to threat: Testing a serotonin transporter genotype × testosterone interaction |journal=Psychoneuroendocrinology |date=1 June 2012 |volume=37 |issue=6 |pages=752–761 |doi=10.1016/j.psyneuen.2011.09.006 |pmid=21978869 |pmc=3262096 |issn=0306-4530}}</ref>
A 2004 experiment tested the hypothesis of overselective attention in psychopaths using two forms of the ]: with color/picture and word separated and with color/picture and word together. They found that in the separated Stroop tasks, psychopaths performed significantly worse than controls; however, on standard Stroop tasks, psychopaths performed equally well as controls.


Studies have suggested other correlations. Psychopathy was associated in two studies with an increased ratio of ] (a ] metabolite) to ] (a ] metabolite).<ref name=Glenn2008/> Studies have found that individuals with the traits meeting criteria for psychopathy show a greater dopamine response to potential "rewards" such as monetary promises or taking drugs such as amphetamines. This has been theoretically linked to increased impulsivity.<ref>{{cite journal |doi=10.1038/nn.2510 |title=Mesolimbic dopamine reward system hypersensitivity in individuals with psychopathic traits |year=2010 |last1=Buckholtz |first1=Joshua W |last2=Treadway |first2=Michael T |last3=Cowan |first3=Ronald L |last4=Woodward |first4=Neil D |last5=Benning |first5=Stephen D |last6=Li |first6=Rui |last7=Ansari |first7=M Sib |last8=Baldwin |first8=Ronald M |last9=Schwartzman |first9=Ashley N |last10=Shelby |first10=Evan S |last11=Smith |first11=Clarence E |last12=Cole |first12=David |last13=Kessler |first13=Robert M |last14=Zald |first14=David H |journal=] |volume=13 |issue=4 |pages=419–21 |pmid=20228805 |pmc=2916168}}</ref> A 2010 British study found that a large 2D:4D ], an indication of high ] ] exposure, was a "positive correlate of psychopathy in females, and a positive correlate of callous affect (psychopathy sub-scale) in males".<ref>{{cite journal |doi=10.5042/bjfp.2010.0183 |title=An investigation into the relationship between digit length ratio (2D: 4D) and psychopathy |year=2010 |last1=Blanchard |first1=Alyson |last2=Lyons |first2=Minna |journal=The British Journal of Forensic Practice |volume=12 |issue=2 |pages=23–31}}</ref>
When split into low-anxious and high-anxious groups, low-anxious psychopaths and low-anxious controls showed less interference on the separated Stroop tasks than their high-anxious counterparts; for low-anxious psychopaths, interference was very nearly zero. They conclude that the inability to integrate contextual cues depends on the cues' relationship to "the deliberately attended, goal-relevant information."<ref name="stroop">{{cite journal |author=Hiatt KD, Schmitt WA, Newman JP |title=Stroop tasks reveal abnormal selective attention among psychopathic offenders |journal=Neuropsychology |volume=18 |issue=1 |pages=50-9 |year=2004 |pmid=14744187 |doi=10.1037/0894-4105.18.1.50}}</ref>

Findings have also shown ] to affect the predictive ability of the PCL-R.<ref name="Tikkanen et al. 2011">{{cite journal |doi=10.1016/j.psychres.2010.08.026 |title=Psychopathy, PCL-R, and MAOA genotype as predictors of violent reconvictions |year=2011 |last1=Tikkanen |first1=Roope |last2=Auvinen-Lintunen |first2=Laura |last3=Ducci |first3=Francesca |last4=Sjöberg |first4=Rickard L. |last5=Goldman |first5=David |last6=Tiihonen |first6=Jari |last7=Ojansuu |first7=Ilkka |last8=Virkkunen |first8=Matti |journal=Psychiatry Research |volume=185 |issue=3 |pages=382–6 |pmid=20850185 |pmc=3506166}}</ref> Monoamine oxidases (MAOs) are enzymes that are involved in the breakdown of neurotransmitters such as serotonin and dopamine and are, therefore, capable of influencing feelings, mood, and behavior in individuals.<ref name=Hook_2009>{{cite journal |author=Hook GR |title="Warrior genes" and the disease of being Māori |journal=MAI Review |year=2009 |issue=2 |pages=1–11 |url=http://www.review.mai.ac.nz/index.php/MR/article/view/222/243 |archive-url=https://web.archive.org/web/20140907092159/http://review.mai.ac.nz/index.php/MR/article/view/222/243 |archive-date=2014-09-07 |access-date=2014-05-07}}</ref> Findings suggest that further research is needed in this area.<ref name="MaoriWarriorGene">{{cite news |url=http://www.nzherald.co.nz/category/story.cfm?c_id=204&objectid=10395491 |archive-url=https://archive.today/20130223035118/http://www.nzherald.co.nz/category/story.cfm?c_id=204&objectid=10395491 |archive-date=February 23, 2013 |title=Maori 'warrior gene' claims appalling, says geneticist |work=News |publisher=] News |access-date=2009-01-27 |date=August 10, 2006}}</ref><ref name="url Scientist debunks 'warrior gene'">{{cite news |url=http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10596821 |title=Scientist debunks 'warrior gene' |work=News |publisher=] |access-date=2009-09-11 |date=September 12, 2009 |archive-date=2020-08-07 |archive-url=https://web.archive.org/web/20200807182430/https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10596821 |url-status=live}}</ref>

== Diagnosis ==

=== Tools ===

==== Psychopathy Checklist ====
{{Main|Psychopathy Checklist}}
Psychopathy is most commonly assessed with the ''Psychopathy Checklist, Revised (PCL-R)'', created by ] based on Cleckley's criteria from the 1940s, criminological concepts such as those of ], and his own research on criminals and incarcerated offenders in Canada.<ref name="HareNeumann2008">{{cite journal |doi=10.1146/annurev.clinpsy.3.022806.091452 |title=Psychopathy as a Clinical and Empirical Construct |year=2008 |last1=Hare |first1=Robert D. |last2=Neumann |first2=Craig S. |journal=] |volume=4 |pages=217–46 |pmid=18370617 |url=http://www.hare.org/references/HareandNeumannARCP2008.pdf |issue=1 |url-status=live |archive-url=https://web.archive.org/web/20130914041634/http://hare.org/references/HareandNeumannARCP2008.pdf |archive-date=2013-09-14 }}</ref><ref name=Blackburn2005> {{Webarchive|url=https://web.archive.org/web/20170404064119/https://books.google.com/books?id=clrGnwE8mrIC |date=2017-04-04 }} Stephen Strack, John Wiley & Sons, 21 Jan 2005. Chapter 15: Psychopathy as a Personality Construct (Ronald Blackburn).</ref><ref> {{Webarchive|url=https://web.archive.org/web/20170404021833/https://books.google.com/books?id=NBC0jOMVmIYC |date=2017-04-04 }} "What are the differences between the psychopathy definitions designed by Hare and by Cleckley?" Editor: Ellsworth Lapham Fersch. iUniverse, 30 Oct 2006</ref> The PCL-R is widely used and is referred to by some as the "gold standard" for assessing psychopathy.<ref name="kiehlhistoryneuroscience">{{cite journal |last1=Kiehl |first1=Kent A. |title=The Criminal Psychopath: History, Neuroscience, Treatment, and Economics |last2=Hoffman |first2=Morris B. |journal=Jurimetrics |date=1 January 2011 |volume=51 |issue=4 |pages=355–397|pmid=24944437 |pmc=4059069 |issn=0897-1277}}</ref> There are nonetheless numerous criticisms of the PCL-R ] and in ].<ref name="Minkel">{{cite web |last=Minkel |first=JR |url=http://www.scientificamerican.com/article.cfm?id=critique-of-forensic-psychopathy-scale-delayed-by-lawsuit |title=Fear Review: Critique of Forensic Psychopathy Scale Delayed 3 Years by Threat of Lawsuit |date=June 17, 2010 |work=Scientific America |url-status=live |archive-url=https://web.archive.org/web/20120318155851/http://www.scientificamerican.com/article.cfm?id=critique-of-forensic-psychopathy-scale-delayed-by-lawsuit |archive-date=March 18, 2012 }}</ref><ref name="ReferenceA">{{cite journal |doi=10.1177/0306624X03259472 |title=The Trouble with Psychopathy as a General Theory of Crime |year=2004 |last1=Walters |first1=Glenn D. |journal=International Journal of Offender Therapy and Comparative Criminology |volume=48 |issue=2 |pages=133–48 |pmid=15070462 |s2cid=40939723}}</ref><ref name="jaapl.org">], MD, Catherine A. Yeager, MA, Pamela Blake, MD, Barbara Bard, PhD, and Maren Strenziok, MS {{Webarchive|url=https://web.archive.org/web/20201123041218/http://jaapl.org/content/jaapl/32/4/408.full.pdf |date=2020-11-23 }} J Am Acad Psychiatry Law 32:408–29, 2004</ref><ref name="Franklin 2011">{{cite web |url=http://www.psychologytoday.com/blog/witness/201104/psychopathy-rorschach-test-psychologists |title=Psychopathy: A Rorschach test for psychologists? |year=2011 |first=Karen |last=Franklin |work=Witness}}</ref>{{self-published inline|date=September 2013}}<ref name="ReferenceB">{{cite journal |doi=10.1177/1073191111402460 |title=On Individual Differences in Person Perception: Raters' Personality Traits Relate to Their Psychopathy Checklist-Revised Scoring Tendencies |year=2011 |last1=Miller |first1=A. K. |last2=Rufino |first2=K. A. |last3=Boccaccini |first3=M. T. |last4=Jackson |first4=R. L. |last5=Murrie |first5=D. C. |journal=Assessment |volume=18 |issue=2 |pages=253–60 |pmid=21393315 |s2cid=206655518}}</ref>

==== Psychopathic Personality Inventory ====
{{Main|Psychopathic Personality Inventory}}
Unlike the PCL, the Psychopathic Personality Inventory (PPI) was developed to comprehensively index personality traits without explicitly referring to antisocial or criminal behaviors themselves. It is a self-report scale that was developed originally for non-clinical samples (e.g. university students) rather than prisoners, though may be used with the latter. It was revised in 2005 to become the PPI-R and now comprises 154 items organized into eight subscales.<ref name="ppi-r">{{cite book |last1=Lilienfeld |first1=S. O. |last2=Widows |first2=M. R. |date=2005 |chapter=Psychopathic Personality Inventory—Revised (PPI-R) professional manual |location=Odessa, FL |publisher=Psychological Assessment Resources}}</ref> The item scores have been found to group into two overarching and largely separate factors (unlike the PCL-R factors), Fearless-Dominance and Impulsive Antisociality, plus a third factor, Coldheartedness, which is largely dependent on scores on the other two.<ref name="gap" /> Factor 1 is associated with social efficacy while Factor 2 is associated with maladaptive tendencies. A person may score at different levels on different factors, but the overall score indicates the extent of psychopathic personality.<ref name="gap" />

==== Triarchic Psychopathy Measure ====
The Triarchic Psychopathy Measure, otherwise known as the TriPM, is a 58-item, self-report assessment that measures psychopathy within the three traits identified in the triarchic model: boldness, meanness, and disinhibition. Each trait is measured on separate subscales and added up resulting in a total psychopathy score.<ref>{{Cite web |title=Triarchic Psychopathy Measure - cplabwiki |url=https://patrickcnslab.psy.fsu.edu/index.php/Triarchic_Psychopathy_Measure |access-date=2022-01-06 |website=patrickcnslab.psy.fsu.edu |archive-date=2022-01-06 |archive-url=https://web.archive.org/web/20220106145234/https://patrickcnslab.psy.fsu.edu/index.php/Triarchic_Psychopathy_Measure |url-status=live}}</ref>

The TriPM includes various components of other measures for assessing psychopathy, including meanness and disinhibition patterns within the psychopathic personality. However, there are differing approaches in the measurement of the boldness construct.<ref>{{Cite journal |last1=Drislane |first1=Laura E. |last2=Patrick |first2=Christopher J. |last3=Arsal |first3=Güler |date=2013-12-09 |title=Clarifying the content coverage of differing psychopathy inventories through reference to the triarchic psychopathy measure |journal=Psychological Assessment |volume=26 |issue=2 |pages=350–362 |doi=10.1037/a0035152 |issn=1939-134X |pmc=4100942 |pmid=24320762}}</ref> The boldness construct is used to highlighting the social and interpersonal implications of the psychopathic personality.

==== DSM and ICD ====
There are currently two widely established systems for classifying ]—the '']'' (ICD) produced by the ] (WHO) and the '']'' (DSM) produced by the ] (APA).<ref>{{Cite web |title=DSM-5: What It Is & What It Diagnoses |url=https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5 |access-date=2023-12-30 |website=Cleveland Clinic |archive-date=2023-12-30 |archive-url=https://web.archive.org/web/20231230021825/https://my.clevelandclinic.org/health/articles/24291-diagnostic-and-statistical-manual-dsm-5 |url-status=live }}</ref><ref>{{Cite web |title=International Classification of Diseases (ICD) |url=https://www.who.int/standards/classifications/classification-of-diseases |access-date=2023-12-30 |website=World Health Organization |archive-date=2023-09-20 |archive-url=https://web.archive.org/web/20230920045132/https://www.who.int/standards/classifications/classification-of-diseases |url-status=live }}</ref> Both list categories of disorders thought to be distinct types, and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain.<ref>{{Cite journal |last1=Surís |first1=Alina |last2=Holliday |first2=Ryan |last3=North |first3=Carol S. |date=2016-01-18 |title=The Evolution of the Classification of Psychiatric Disorders |journal=Behavioral Sciences |volume=6 |issue=1 |pages=5 |doi=10.3390/bs6010005 |doi-access=free |issn=2076-328X |pmc=4810039 |pmid=26797641}}</ref>

The first edition of the DSM in 1952 had a section on sociopathic personality disturbances, then a general term that included such things as homosexuality and alcoholism as well as an "antisocial reaction" and "dyssocial reaction". The latter two eventually became ] (ASPD) in the DSM and ] in the ICD.{{Citation needed|date=July 2013}} Both manuals have stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy, although neither diagnostic manual has ever included a disorder officially titled as such.<ref name="gap" /><ref name="Handbook of Psychopathy">{{cite book |last=Patrick |first=Christopher |title=Handbook of Psychopathy |year=2005 |publisher=] |isbn=978-1-60623-804-2}}{{page needed|date=September 2013}}</ref><ref name="aspd statement" />

==== Other tools ====
There are some traditional ] that contain subscales relating to psychopathy, though they assess relatively non-specific tendencies towards antisocial or criminal behavior. These include the ] (Psychopathic Deviate scale), ] (Socialization scale), and ] Antisocial Personality Disorder scale. There is also the ] (LSRP) and the Hare Self-Report Psychopathy Scale (HSRP), but in terms of self-report tests, the PPI/PPI-R has become more used than either of these in modern psychopathy research on adults.<ref name="gap" />

=== Comorbidity ===
Studies suggest strong comorbidity between psychopathy and ]. Among numerous studies, positive correlations have also been reported between psychopathy and ], ], ], ], and ] ]s, ] and ] disorders, but not ] disorders in general, ], or ].<ref name="englandandwales2009" /><ref name=BlairMitchellBlair>{{cite book |title=Psychopathy, emotion and the brain |last=Blair |first=J |author2=Mitchel D |author3=Blair K |year=2005 |isbn=978-0-631-23336-7 |publisher=] |pages=25–7 |url=https://www.scribd.com/doc/27005161/The-Psychopath-Emotion-and-the-Brain |url-status=live |archive-url=https://web.archive.org/web/20160306020403/https://www.scribd.com/doc/27005161/The-Psychopath-Emotion-and-the-Brain |archive-date=2016-03-06 }}</ref><ref name=Nioche>{{cite journal |doi=10.1016/j.encep.2009.07.004 |title=Psychopathie et troubles de la personnalité associés: Recherche d'un effet particulier au trouble borderline ? |trans-title=Psychopathy and associated personality disorders: Searching for a particular effect of the borderline personality disorder? |language=fr |year=2010 |last1=Nioche |first1=A. |last2=Pham |first2=T.H. |last3=Ducro |first3=C. |last4=De Beaurepaire |first4=C. |last5=Chudzik |first5=L. |last6=Courtois |first6=R. |last7=Réveillère |first7=C. |journal=L'Encéphale |volume=36 |issue=3 |pages=253–9 |pmid=20620268}}</ref><ref name=Hildebrand>{{cite journal |doi=10.1016/j.ijlp.2004.03.005 |title=PCL-R psychopathy and its relation to DSM-IV Axis I and II disorders in a sample of male forensic psychiatric patients in the Netherlands |year=2004 |last1=Hildebrand |first1=Martin |last2=De Ruiter |first2=Corine |journal=International Journal of Law and Psychiatry |volume=27 |issue=3 |pages=233–48 |pmid=15177992}}</ref><ref name=Nedopil>{{cite book |doi=10.1007/978-94-011-3965-6_12 |chapter=Comorbidity of Psychopathy with Major Mental Disorders |chapter-url=https://books.google.com/books?id=lqMZzZ7p3jIC&pg=PA257 |title=Psychopathy: Theory, Research and Implications for Society |year=1998 |last1=Nedopil |first1=Norbert |last2=Hollweg |first2=Matthias |last3=Hartmann |first3=Julia |last4=Jaser |first4=Robert |isbn=978-0-7923-4920-4 |pages=257–68 |access-date=2016-02-03 |archive-date=2017-04-04 |archive-url=https://web.archive.org/web/20170404052423/https://books.google.com/books?id=lqMZzZ7p3jIC&pg=PA257 |url-status=live |via=]}}</ref>

Factor 1 and the boldness scale of psychopathy measurements are associated with narcissism and histrionic personality disorder. This is due to a psychopath's cognitive and affective egocentrism. However, while a narcissistic individual might view themselves as confident, they might seek out validation and attention from others to validate their self-worth, whereas a psychopathic individual usually lacks such ambitions.<ref name="Yildirim, Bariş O. 2015"/>

Attention deficit hyperactivity disorder (]) is known to be highly comorbid with ] (a theorized precursor to ASPD), and may also co-occur with psychopathic tendencies. This may be explained in part by deficits in ].<ref name=BlairMitchellBlair/> ] often co-occur with ASPD, and contrary to assumptions, psychopathy can sometimes be marked by anxiety; this appears to be related to items from Factor 2 but not Factor 1 of the PCL-R.<ref name="Yildirim, Bariş O. 2015"/> Psychopathy is also associated with ].<ref name="neumann1" /><ref name=BlairMitchellBlair/><ref name=Hildebrand/><ref>{{cite journal |doi=10.1037/0021-843X.99.4.430 |title=Alcohol and drug abuse-dependence disorders in psychopathic and nonpsychopathic criminal offenders |year=1990 |last1=Smith |first1=Stevens S. |last2=Newman |first2=Joseph P. |journal=] |volume=99 |issue=4 |pages=430–9 |pmid=2266219}}</ref><ref name=Kantor>{{cite book |last=Kantor |first=Martin |title=The Psychopathy of Everyday Life |isbn=978-0-275-98798-5 |year=2006 |page=107|publisher=Bloomsbury Academic }}</ref>

] suggested overlaps between (primary) psychopathy and ] in terms of fearlessness, planning of acts, empathy deficits, callous behaviour, and sometimes superficial charisma.<ref>{{cite journal |last=Fitzgerald |first=M. |date=2003 |title=Callous-unemotional traits and Asperger's syndrome? |journal=] |volume=42 |number=9 |page=1011|doi=10.1097/01.CHI.0000070252.24125.CD |pmid=12964563 }}</ref> Studies investigating similarities and differences between psychopathy and autism indicate that autism and psychopathy are not part of the same construct. Rather both conditions might co-occur in some individuals.<ref>{{cite journal |last=Rogers |first=John |others=et al. |title=Autism spectrum disorder and psychopathy: shared cognitive underpinnings or double hit?. |journal=Psychological Medicine |volume=36 |number=12 |date=2006 |pages=1789–1798 |doi=10.1017/S0033291706008853 |pmid=17018169 |s2cid=2566320 |url=https://discovery.ucl.ac.uk/id/eprint/11879/ |access-date=2023-03-04 |archive-date=2023-03-07 |archive-url=https://web.archive.org/web/20230307145116/https://discovery.ucl.ac.uk/id/eprint/11879/ |url-status=live }}</ref> Recent studies indicate that some individuals with an autism diagnosis also show ] (a risk-factor for developing psychopathy),<ref>{{cite journal |last=O'Nions |first=Elizabeth |others=et al. |title=Examining the genetic and environmental associations between autistic social and communication deficits and psychopathic callous-unemotional traits. |journal=] |volume=10 |number=9 |date=2015 |page=e0134331|doi=10.1371/journal.pone.0134331 |pmid=26325039 |pmc=4556482 |bibcode=2015PLoSO..1034331O |doi-access=free }}</ref> but are less strongly associated with ].<ref>{{cite journal |last=Leno |first=Virginia Carter |others=et al. |title=Callous–unemotional traits in adolescents with autism spectrum disorder |journal=The British Journal of Psychiatry |volume=207 |number=5 |date=2015 |pages=392–399|doi=10.1192/bjp.bp.114.159863 |pmid=26382954 |pmc=4629071 }}</ref> Likewise, some people with Asperger syndrome have shown correlations with the "unemotional" factor and "behavioural dyscontrol" factor of psychopathy, but not the "interpersonal" factor.<ref>{{cite journal |last1=Dein |first1=K. |last2=Woodbury-Smith |first2=M. |date=2010 |title=Asperger syndrome and criminal behaviour |journal=] |volume=16 |number=1 |pages=37–43 |doi=10.1192/apt.bp.107.005082 |quote=In the UK, Murphy (2007) found that none of the patients with Asperger syndrome at Broadmoor Hospital received an overall score on the PCL–R above the cut-off for psychopathy. Interestingly, in the different domains of the PCL–R these individuals frequently received higher scores on the affective component (including features such as lack of remorse or guilt, shallow affect, lack of empathy, and failure to accept responsibility for one's actions) and lower scores on the other components than did a comparison group of the hospital's patients without Asperger syndrome. (...) In Sweden, however, Nilsson and Soderstrom et al (2005) found that the total PCL–R scores, as well as scores on the 'unemotionality' and 'behavioural dyscontrol' factors, were significantly correlated with high-functioning autistic traits. The 'interpersonal' factor of the PCL–R showed none of these correlations, leading the authors to conclude that scores on this factor may capture features that are specific to psychopathy, distinguishing core psychopathy from other diagnostic definitions.|doi-access=free }}</ref>

It has been suggested that psychopathy may be comorbid with several other conditions than these,<ref name=Kantor/> but limited work on comorbidity has been carried out. This may be partly due to difficulties in using inpatient groups from certain institutions to assess comorbidity, owing to the likelihood of some bias in sample selection.<ref name=BlairMitchellBlair/>

=== Sex differences ===
Research on psychopathy has largely been done on men and the PCL-R was developed using mainly male criminal samples, raising the question of how well the results apply to women. Men score higher than women on both the PCL-R and the PPI and on both of their main scales. The differences tend to be somewhat larger on the interpersonal-affective scale than on the antisocial scale. Most but not all studies have found broadly similar ] for men and women.<ref name="gap" />

Many associations with other personality traits are similar, although in one study the antisocial factor was more strongly related to impulsivity in men and more strongly related to ] in women. It has been suggested that psychopathy in men manifests more as an ] pattern while in women it manifests more as a ] pattern. Studies on this have shown mixed results. PCL-R scores may be somewhat less predictive of violence and recidivism in women. On the other hand, psychopathy may have a stronger relationship with suicide and possibly internalizing symptoms in women. A suggestion is that psychopathy manifests more as externalizing behaviors in men and more as internalizing behaviors in women.<ref name="gap" /> Furthermore, one study has suggested substantial gender differences were found in the ] of psychopathy. For girls, 75% of the ] in severe ] was attributable to environmental factors and just 0% of the variance was attributable to genetic factors. In boys, the link was reversed.<ref>{{Cite journal |last1=Fontaine |first1=Nathalie M. G. |last2=Rijsdijk |first2=Frühling V. |last3=McCrory |first3=Eamon J. P. |last4=Viding |first4=Essi |title=Etiology of Different Developmental Trajectories of Callous-Unemotional Traits |journal=Journal of the American Academy of Child & Adolescent Psychiatry |year=2010 |volume=49 |issue=7 |pages=656–664 |doi=10.1016/j.jaac.2010.03.014 |pmid=20610135}}</ref>

Studies have also found that women in prison score significantly lower on psychopathy than men, with one study reporting only 11 percent of violent females in prison met the psychopathy criteria in comparison to 31 percent of violent males.<ref>{{Cite journal |title=Psychopathy in women: theoretical and clinical perspectives |journal = International Journal of Women's Health |date=2012-06-01 |issn=1179-1411 |pmc=3379858 |pmid=22723733 |pages=257–263 |volume=4 |doi=10.2147/IJWH.S25518 |first1=Rolf |last1=Wynn |first2=Marita H. |last2=Høiseth |first3=Gunn |last3=Pettersen |doi-access = free }}</ref> Other studies have also indicated that high psychopathic females are rare in forensic settings.<ref>{{Cite journal |title= |journal=Der Nervenarzt |date=2014-03-01 |issn=1433-0407 |pmid=24549689 |pages=290, 292–294, 296–297 |volume=85 |issue=3 |doi=10.1007/s00115-013-3902-9 |first=H. |last=Eisenbarth |s2cid=38652290 |url=https://eprints.soton.ac.uk/384812/1/A3C2B0E5-0D57-4FD0-8A0D-3FCB87DC92D1.pdf |access-date=2022-01-25 |archive-date=2020-08-06 |archive-url=https://web.archive.org/web/20200806143913/https://eprints.soton.ac.uk/384812/1/A3C2B0E5-0D57-4FD0-8A0D-3FCB87DC92D1.pdf |url-status=live}}</ref>

== Management ==

=== Clinical ===
Psychopathy has often been considered untreatable. Its unique characteristics make it among the most ] of ]s, a class of mental illnesses that are already traditionally considered ].<ref name="Vien2006" >{{cite journal |last1=Vien |first1=Anh |last2=Beech |first2=Anthony R. |title=Psychopathy: theory, measurement, and treatment |journal=Trauma, Violence & Abuse |date=1 July 2006 |volume=7 |issue=3 |pages=155–174 |doi=10.1177/1524838006288929 |pmid=16785285 |s2cid=220339235 |issn=1524-8380}}</ref><ref>{{cite web |last1=Dingfelder |first1=Sadie F. |title=Treatment for the 'untreatable' |url=http://www.apa.org/monitor/mar04/treatment.aspx |website=American Psychological Association |access-date=12 March 2016 |date=March 2004 |url-status=live |archive-url=https://web.archive.org/web/20160308081259/http://www.apa.org/monitor/mar04/treatment.aspx |archive-date=8 March 2016}}</ref> People with psychopathy are generally ] for their condition, and can be uncooperative in therapy.<ref name="kiehlhistoryneuroscience" /><ref name="Vien2006" /> Attempts to treat psychopathy with the current tools available to psychiatry have been disappointing. Harris and Rice's ''Handbook of Psychopathy'' says that there is currently little evidence for a cure or effective treatment for psychopathy; as yet, no ] are known to or have been trialed for alleviating the emotional, interpersonal and moral deficits of psychopathy, and patients with psychopathy who undergo ] might gain the skills to become more adept at the manipulation and deception of others and be more likely to commit crime.<ref name="Patrick 2006 555–572">{{cite book |last1=Harris |first1=Grant T. |last2=Rice |first2=Marnie E. |chapter=Treatment of Psychopathy: A Review of Empirical Findings |editor1-last=Patrick |editor1-first=Christopher J. |year=2006 |title=Handbook of psychopathy |pages=555–72 |location=New York |publisher=] |isbn=978-1-59385-591-8}}</ref> Some studies suggest that punishment and ] are ineffective at modifying the behavior of psychopathic individuals as they are insensitive to punishment or threat.<ref name="Patrick 2006 555–572"/><ref>{{cite journal |last1=Gregory |first1=Sarah |last2=Blair |first2=R James |last3=ffytche |first3=Dominic |last4=Simmons |first4=Andrew |last5=Kumari |first5=Veena|author5-link=Veena Kumari |last6=Hodgins |first6=Sheilagh |last7=Blackwood |first7=Nigel |title=Punishment and psychopathy: a case-control functional MRI investigation of reinforcement learning in violent antisocial personality disordered men |journal=] |date=February 2015 |volume=2 |issue=2 |pages=153–160 |doi=10.1016/S2215-0366(14)00071-6 |pmid=26359751 |url=http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366%2814%2900071-6/abstract |access-date=12 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20180209190618/http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00071-6/abstract |archive-date=9 February 2018}}</ref> These failures have led to a widely pessimistic view on its treatment prospects, a view that is exacerbated by the little research being done into psychopathy compared to the efforts committed to other mental illnesses, which makes it more difficult to gain the understanding of this condition that is necessary to develop effective therapies.<ref>{{cite web |title=The Hard Sell for Psychopathy Research Funding |url=http://www.neulaw.org/blog/1034-class-blog/304-the-hard-sell-for-psychopathy-research-funding |website=Center for Science and Law |access-date=10 March 2016 |archive-url=https://web.archive.org/web/20160310201244/http://www.neulaw.org/blog/1034-class-blog/304-the-hard-sell-for-psychopathy-research-funding |archive-date=10 March 2016}}</ref><ref>{{Cite magazine |last1=Seabrook |first1=John |title=Suffering Souls: The search for the roots of psychopathy |url=http://www.newyorker.com/magazine/2008/11/10/suffering-souls |magazine=] |access-date=10 March 2016 |date=November 2008 |url-status=live |archive-url=https://web.archive.org/web/20160310092532/http://www.newyorker.com/magazine/2008/11/10/suffering-souls |archive-date=10 March 2016}}</ref>

Although the core character deficits of highly psychopathic individuals are likely to be highly incorrigible to the currently available treatment methods, the antisocial and criminal behavior associated with it may be more amenable to management, the management of which being the main aim of therapy programs in correctional settings.<ref name="Vien2006" /> It has been suggested that the treatments that may be most likely to be effective at reducing overt antisocial and criminal behavior are those that focus on self-interest, emphasizing the tangible, material value of prosocial behavior, with interventions that develop skills to obtain what the patient wants out of life in prosocial rather than antisocial ways.<ref name="Beck">Beck, Aaron T., Freeman, Arthur, Davis, Denise D. (2006) ''Cognitive Therapy of Personality Disorders. Second Edition.'' The Guilford Press. {{ISBN|978-1-59385-476-8}}.</ref><ref name="Chivers">{{cite news |last=Chivers |first=Tom |date=2014-04-06 |title=Psychopaths: how can you spot one? |url=https://www.telegraph.co.uk/culture/books/10737827/Psychopaths-how-can-you-spot-one.html |newspaper=] |access-date=2015-01-13 |url-status=live |archive-url=https://web.archive.org/web/20150109012412/http://www.telegraph.co.uk/culture/books/10737827/Psychopaths-how-can-you-spot-one.html |archive-date=2015-01-09}}</ref> To this end, various therapies have been tried with the aim of reducing the criminal activity of incarcerated offenders with psychopathy, with mixed success.<ref name="Vien2006" /> As psychopathic individuals are insensitive to sanction, reward-based management, in which small privileges are granted in exchange for good behavior, has been suggested and used to manage their behavior in institutional settings.<ref>{{cite web |last1=Bonn |first1=Scott A. |title=Psychopathic Criminals Cannot Be Cured |url=https://www.psychologytoday.com/blog/wicked-deeds/201408/psychopathic-criminals-cannot-be-cured |website=Psychology Today |publisher=Sussex Publishers, LLC |access-date=12 March 2016 |date=August 2014 |archive-date=20 February 2023 |archive-url=https://web.archive.org/web/20230220135210/https://www.psychologytoday.com/intl/blog/wicked-deeds/201408/cure-psychopathic-criminals |url-status=live }}</ref>

Psychiatric medications may also alleviate co-occurring conditions sometimes associated with psychopathy or with symptoms such as aggression or impulsivity, including ], ] or ] medications, although none have yet been approved by the ] for this purpose.<ref name="gap" /><ref name="Handbook of Psychopathy" /><ref name="aspd statement" /><ref name="dsm-5 pocket guide">{{cite book |last=Nussbaum |first=Abraham |year=2013 |title=The Pocket Guide to the DSM-5 Diagnostic Exam |url=https://books.google.com/books?id=rEPy72wKdswC |location=Arlington, VA |publisher=American Psychiatric Publishing |isbn=978-1-58562-466-9 |access-date=January 5, 2014 |archive-date=January 2, 2017 |archive-url=https://web.archive.org/web/20170102201826/https://books.google.com/books?id=rEPy72wKdswC |url-status=live}}</ref><ref name="aspd meds">{{cite web |url=http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829/DSECTION=treatments-and-drugs |title=Antisocial personality disorder: Treatments and drugs |author=Mayo Clinic staff |date=12 April 2013 |website=] |publisher=] |access-date=17 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131110001527/http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829/DSECTION=treatments%2Dand%2Ddrugs |archive-date=10 November 2013}}</ref> For example, a study found that the antipsychotic ] may be effective in reducing various behavioral dysfunctions in a sample of high-security hospital inpatients with antisocial personality disorder and psychopathic traits.<ref>{{cite journal |last1=Brown |first1=Darcy |last2=Larkin |first2=Fintan |last3=Sengupta |first3=amratS |last4=Romero-Ureclay |first4=Jose L. |last5=Ross |first5=Callum C. |last6=Gupta |first6=Nitin |last7=Vinestock |first7=Morris |last8=Das |first8=Mrigendra |title=Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high-security hospital. |journal=CNS Spectrums |date=October 2014 |volume=19 |issue=5 |pages=391–402 |doi=10.1017/S1092852914000157 |pmid=24698103 |pmc=4255317}}</ref> However, research into the pharmacological treatment of psychopathy and the related condition antisocial personality disorder is minimal, with much of the knowledge in this area being extrapolations based on what is known about ] in other mental disorders.<ref name="Vien2006" /><ref>{{Cite journal |last1=Khalifa |first1=Najat R. |last2=Gibbon |first2=Simon |last3=Völlm |first3=Birgit A. |last4=Cheung|first4=Natalie H.-Y. |last5=McCarthy |first5=Lucy |date=3 September 2020 |title=Pharmacological interventions for antisocial personality disorder |journal=The Cochrane Database of Systematic Reviews |volume=2020 |issue=9 |pages=CD007667 |doi=10.1002/14651858.CD007667.pub3 |issn=1469-493X |pmid=32880105 |pmc=8094881}}</ref>

=== Legal ===
The PCL-R, the PCL:SV, and the PCL:YV are highly regarded and widely used in ] settings, particularly in ]. They may be used for risk assessment and for assessing treatment potential and be used as part of the decisions regarding bail, sentence, which prison to use, parole, and whether a youth should be tried as a juvenile or as an adult. There have been several criticisms against its use in legal settings. They include the general criticisms against the PCL-R, the availability of other risk assessment tools that may have advantages, and the excessive pessimism surrounding the prognosis and treatment possibilities of those who are diagnosed with psychopathy.<ref name="gap" />

The interrater ] of the PCL-R can be high when used carefully in research but tends to be poor in applied settings. In particular Factor 1 items are somewhat subjective. In sexually violent predator cases the PCL-R scores given by prosecution experts were consistently higher than those given by defense experts in one study. The scoring may also be influenced by other differences between raters. In one study it was estimated that of the PCL-R variance, about 45% was due to true offender differences, 20% was due to which side the rater testified for, and 30% was due to other rater differences.<ref name="gap" />

To aid a criminal investigation, certain interrogation approaches may be used to exploit and leverage the personality traits of suspects thought to have psychopathy and make them more likely to divulge information.<ref name=":3">O'Toole, Mary Ellen; Matt Logan; Sharon Smith. "Looking Behind the Mask: Implications for Interviewing Psychopaths". ''FBI Law Enforcement Bulletin'', July 2012, p. 14.</ref>

==== United Kingdom ====
The PCL-R score cut-off for a label of psychopathy is 25 out of 40 in the ], instead of 30 as it is in the ].<ref name="gap" /><ref name="Semple" />

In the United Kingdom, "psychopathic disorder" was legally defined in the Mental Health Act (UK), under MHA1983,<ref name="Semple" /><ref name="ukmha">The Mental Health Act (UK) {{webarchive|url=https://web.archive.org/web/20051117212847/http://www.archive.official-documents.co.uk/document/cm50/5016-ii/5016ii.htm |date=2005-11-17 }} 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". This term was intended to reflect the presence of a personality disorder in terms of conditions for detention under the Mental Health Act 1983. Amendments to MHA1983 within the ] abolished the term "psychopathic disorder", with all conditions for detention (e.g. mental illness, personality disorder, etc.) encompassed by the generic term of "mental disorder".<ref name=":4">See Section 1 of the act {{webarchive|url=https://web.archive.org/web/20150423023736/http://www.legislation.gov.uk/ukpga/2007/12/section/1 |date=2015-04-23 }}.</ref>

In ] and ], the diagnosis of ] is grounds for detention in secure ]s under the ] if they have committed serious crimes, but since such individuals are disruptive to other patients and not responsive to usual treatment methods this alternative to ] is often not used.<ref>{{Cite book |author1=Harrison, Paul |author2=John Geddes |url=https://books.google.com/books?id=xjaQa-OseQ0C&q=dissocial+personality+disorder&pg=PA165 |title=Lecture Notes: Psychiatry |publisher=] |pages=163–165 |isbn=978-1-4051-1869-9 |date=2005-07-18 |access-date=2020-11-19 |archive-date=2021-01-25 |archive-url=https://web.archive.org/web/20210125181731/https://books.google.com/books?id=xjaQa-OseQ0C&q=dissocial+personality+disorder&pg=PA165 |url-status=live |via=]}}</ref>

==== United States ====

===== "Sexual psychopath" laws =====
Starting in the 1930s, before some modern concepts of psychopathy were developed, "sexual psychopath" laws, the term referring broadly to mental illness, were introduced by some states, and by the mid-1960s more than half of the states had such laws. Sexual offenses were considered to be caused by underlying mental illnesses, and it was thought that sex offenders should be treated, in agreement with the general rehabilitative trends at this time. Courts committed sex offenders to a mental health facility for community protection and treatment.<ref name=":5">{{cite journal |last1=Hacker |first1=Frederick J. |last2=Frym |first2=Marcel |title=The Sexual Psychopath Act In Practice: A Critical Discussion |journal=] |date=December 1955 |volume=43 |issue=5 |pages=766–80 |doi=10.2307/3478417 |url=http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=3311&context=californialawreview |access-date=5 April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160416114703/http://scholarship.law.berkeley.edu/cgi/viewcontent.cgi?article=3311&context=californialawreview |archive-date=16 April 2016 |jstor=3478417}}</ref><ref name="JamesThomasFoley">{{cite web |author1=Nathan James |author2=Kenneth R. Thomas |author3=Cassandra Foley |url=http://assets.opencrs.com/rpts/RL34068_20070702.pdf |title=Commitment of Sexually Dangerous Persons |access-date=2012-06-23 |archive-url=https://web.archive.org/web/20121105091726/http://assets.opencrs.com/rpts/RL34068_20070702.pdf |archive-date=2012-11-05 |date=July 2, 2007 |publisher=Congressional Research Service}}</ref>

Starting in 1970, many of these laws were modified or abolished in favor of more traditional responses such as imprisonment due to criticism of the "sexual psychopath" concept as lacking scientific evidence, the treatment being ineffective, and predictions of future offending being dubious. There were also a series of cases where persons treated and released committed new sexual offenses. Starting in the 1990s, several states have passed ], including registration, housing restrictions, public notification, mandatory reporting by health care professionals, and civil commitment, which permits indefinite confinement after a sentence has been completed.<ref name="JamesThomasFoley"/> Psychopathy measurements may be used in the confinement decision process.<ref name="gap" />

== Prognosis ==
The prognosis for psychopathy in forensic and clinical settings is quite poor, with some studies reporting that treatment may worsen the antisocial aspects of psychopathy as measured by ] rates, though it is noted that one of the frequently cited studies finding increased criminal recidivism after treatment, a 2011 retrospective study of a treatment program in the 1960s, had several serious methodological problems and likely would not be approved of today.<ref name="gap" /><ref name="kiehlhistoryneuroscience" /> However, some relatively rigorous quasi-experimental studies using more modern treatment methods have found improvements regarding reducing future violent and other criminal behavior, regardless of PCL-R scores, although none were ]. Various other studies have found improvements in risk factors for crime such as substance abuse. No study has yet examined whether the personality traits that form the core character disturbances of psychopathy could be changed by such treatments.<ref name="gap" /><ref name="polaschek2013">{{cite journal |author1-link=Devon Polaschek |last1=Polaschek |first1=Devon L.L. |last2=Daly |first2=Tadhg E. |title=Treatment and psychopathy in forensic settings |journal=Aggression and Violent Behavior |date=September 2013 |volume=18 |issue=5 |pages=592–603 |doi=10.1016/j.avb.2013.06.003}}</ref>

== Frequency ==
A 2008 study using the PCL:SV found that 1.2% of a US sample scored 13 or more out of 24, indicating "potential psychopathy". The scores correlated significantly with violence, alcohol use, and lower intelligence.<ref name="neumann1">{{cite journal |doi=10.1037/0022-006X.76.5.893 |title=Psychopathic traits in a large community sample: Links to violence, alcohol use, and intelligence |year=2008 |last1=Neumann |first1=Craig S. |last2=Hare |first2=Robert D. |journal=] |volume=76 |pages=893–9 |pmid=18837606 |issue=5 |url=http://www.hare.org/references/NeumannandHareJCCP2008.pdf |url-status=live |archive-url=https://web.archive.org/web/20111203071514/http://www.hare.org/references/NeumannandHareJCCP2008.pdf |archive-date=2011-12-03}}</ref> A 2009 British study by Coid et al., also using the PCL:SV, reported a community prevalence of 0.6% scoring 13 or more. However, if the scoring was adjusted to the recommended 18 or more,<ref name="cooke">{{cite journal |doi=10.1037/1040-3590.11.1.3 |title=Evaluating the Screening Version of the Hare Psychopathy Checklist—Revised (PCL: SV): An Item Response Theory Analysis |year=1999 |last1=Cooke |first1=David J. |last2=Michie |first2=Christine |last3=Hart |first3=Stephen D. |last4=Hare |first4=Robert D. |journal=Psychological Assessment |volume=11 |pages=3–13 |issue=1 |url=https://www.researchgate.net/publication/232570257 |access-date=2019-07-15 |archive-date=2020-08-06 |archive-url=https://web.archive.org/web/20200806222404/https://www.researchgate.net/publication/232570257 |url-status=live}}</ref> this would have left the prevalence closer to 0.1%.<ref name=":6">{{cite web |url=https://www.psychopathtest.com/ |title=Frequently asked questions |website=Psychopath Test |access-date=15 July 2019 |archive-date=6 January 2021 |archive-url=https://web.archive.org/web/20210106012306/https://www.psychopathtest.com/ |url-status=live}}</ref>{{Unreliable source?|date=August 2022}} The scores correlated with younger age, male gender, suicide attempts, violence, imprisonment, homelessness, drug dependence, personality disorders (histrionic, borderline and antisocial), and panic and obsessive–compulsive disorders.<ref name="coid">{{cite journal |author1=Coid J |author2=Yang M |author3=Ullrich S |author4=Roberts A |author5=Hare RD |title=Prevalence and correlates of psychopathic traits in the household population of Great Britain |journal=] |volume=32 |issue=2 |pages=65–73 |year=2009 |pmid=19243821 |doi=10.1016/j.ijlp.2009.01.002 |url=http://roar.uel.ac.uk/660/1/Coid%2C%20JW%20%282009%29%20IJLP%2032%20%282%29%2065-73.pdf |access-date=2022-01-25 |archive-date=2020-11-23 |archive-url=https://web.archive.org/web/20201123041506/https://repository.uel.ac.uk/download/205a1ede0ed89beb564f218560216129c94d4320f39a5edac15b7be5bdcf1242/186297/Coid%2C%20JW%20%282009%29%20IJLP%2032%20%282%29%2065-73.pdf |url-status=live}}</ref>

Psychopathy has a much higher prevalence in the convicted and incarcerated population, where it is thought that an estimated 15–25% of prisoners qualify for the diagnosis.<ref name="pcl-r" /> A study on a sample of inmates in the UK found that 7.7% of the inmates interviewed met the PCL-R cut-off of 30 for a diagnosis of psychopathy.<ref name="englandandwales2009" /> A study on a sample of inmates in Iran using the PCL:SV found a prevalence of 23% scoring 18 or more.<ref name=":7">{{cite journal|last1=Assadi |first1=Seyed Mohammad |last2=Noroozian |first2=Maryam |last3=Pakravannejad |first3=Mahdi |last4=Yahyazadeh |first4=Omid |last5=Aghayan |first5=Shahrokh |last6=Shariat |first6=Seyed Vahid |last7=Fazel |first7=Seena |title=Psychiatric morbidity among sentenced prisoners: prevalence study in Iran |journal=The British Journal of Psychiatry |date=February 2006 |volume=188 |issue=2 |pages=159–164 |doi=10.1192/bjp.188.2.159 |pmid=16449704 |doi-access=free}}</ref> A study by Nathan Brooks from ] found that around one in five corporate bosses display clinically significant psychopathic traits - a proportion similar to that among prisoners.<ref name=":9">{{Cite news |url=https://www.independent.co.uk/news/world/australasia/psychopaths-ceos-study-statistics-one-in-five-psychopathic-traits-a7251251.html |title=A disturbing number of bosses are psychopaths |date=2016-09-13 |work=] |access-date=2018-02-16 |url-status=live |archive-url=https://web.archive.org/web/20180216084926/http://www.independent.co.uk/news/world/australasia/psychopaths-ceos-study-statistics-one-in-five-psychopathic-traits-a7251251.html |archive-date=2018-02-16}}</ref>

== Society and culture ==

=== In the workplace ===
{{Main|Psychopathy in the workplace}}
There is limited research on psychopathy in the general work populace, in part because the PCL-R includes antisocial behavior as a significant core factor (obtaining a PCL-R score above the threshold is unlikely without having significant scores on the antisocial-lifestyle factor) and does not include positive adjustment characteristics, and most researchers have studied psychopathy in incarcerated criminals, a relatively accessible population of research subjects.<ref name="Disordered personalities at work" />

However, psychologists Fritzon and Board, in their study comparing the incidence of personality disorders in business executives against criminals detained in a mental hospital, found that the profiles of some senior business managers contained significant elements of personality disorders, including those referred to as the "emotional components", or interpersonal-affective traits, of psychopathy. Factors such as boldness, disinhibition, and meanness as defined in the triarchic model, in combination with other advantages such as a favorable upbringing and high intelligence, are thought to correlate with stress immunity and stability, and may contribute to this particular expression.<ref name="Disordered personalities at work">{{cite journal |doi=10.1080/10683160310001634304 |title=Disordered personalities at work |year=2005 |last1=Board |first1=Belinda Jane |last2=Fritzon |first2=Katarina |journal=Psychology, Crime & Law |volume=11 |issue=1 |pages=17–32 |s2cid=145582366}}</ref> Such individuals are sometimes referred to as "successful psychopaths" or "corporate psychopaths" and they may not always have extensive histories of traditional criminal or antisocial behavior characteristic of the traditional conceptualization of psychopathy.<ref name="Successful and unsuccessful">{{cite journal |last1=Gao |first1=Yu |last2=Raine |first2=Adrian |title=Successful and unsuccessful psychopaths: a neurobiological model |journal=] |date=March 2010 |volume=28 |issue=2 |pages=194–210 |doi=10.1002/bsl.924 |pmid=20422645}}</ref> Robert Hare claims that the prevalence of psychopathic traits is higher in the business world than in the general population, reporting that while about 1% of the general population meet the clinical criteria for psychopathy, figures of around 3–4% have been cited for more senior positions in business.<ref name="gap" /><ref name="Hare, R 1994, pp. 54">{{cite journal |last=Hare |first=R. D. |date=1994 |title=Predators: The Disturbing World of the Psychopaths among Us |journal=] |volume=27 |number=1 |pages=54–61}}</ref><ref name= Snakes>{{cite book |last1=Baibak |first1=P. |last2=Hare |first2=R. D. |title=] |date=2007}}</ref>{{Page needed |date=July 2017}} Hare considers newspaper tycoon ] to have been a strong candidate as a "corporate psychopath".<ref name="Conscience">{{cite book |last=Hare |first=R. D. |date=1993 |title=Without conscience: The disturbing world of the psychopaths among us |location=New York, NY |publisher=]}}</ref>

Academics on this subject believe that although psychopathy is manifested in only a small percentage of workplace staff, it is more common at higher levels of corporate organizations, and its negative effects (for example, increased ], ], ], ], ], reduction in ]) often causes a ripple effect throughout an organization, setting the tone for an entire ]. Employees with the disorder are self-serving opportunists, and may disadvantage their own organizations to further their own interests.<ref name="Boddy1">{{cite book |last=Boddy |first=C. R. |title=Corporate Psychopaths: Organizational Destroyers |date=2011}}</ref>{{Page needed |date=July 2017}} They may be ] to staff above their level in the workplace hierarchy, aiding their ascent through the organization, but abusive to staff below their level, and can do enormous damage when they are positioned in senior management roles.<ref name="Boddy2">Boddy. C. R (2005) "'The Implications for Business Performance and Corporate Social Responsibility of Corporate Psychopaths" in 2nd International Conference on Business Performance and Corporate Social Responsibility, ed. M. Hopkins, Middlesex University Business School, London</ref>{{Page needed |date=July 2017}}<ref name="Walker">Walker, I. 2005, Psychopaths in Suits, Australian Broadcasting Corporation</ref>{{Page needed |date=July 2017}} Psychopathy as measured by the PCL-R is associated with lower performance appraisals among corporate professionals.<ref name="Babiak">{{cite journal |last1=Babiak |first1=Paul |last2=Neumann |first2=Craig S |last3=Hare |first3=Robert D |title=Corporate psychopathy: Talking the walk |journal=] |date=April 2010 |volume=28 |issue=2 |pages=174–93 |doi=10.1002/bsl.925 |pmid=20422644|s2cid=15946623 }}</ref> The psychologist ] identifies psychopathy as one of the ]ic traits in the workplace, the others being narcissism and Machiavellianism, which, like psychopathy, can have negative consequences.<ref>a{{Citation |last=James |first=O |title=Office Politics: How to Thrive in a World of Lying, Backstabbing and Dirty Tricks |year=2013|page=21}}.</ref>

According to a study from the University of Notre Dame published in the ''Journal of Business Ethics,'' psychopaths have a natural advantage in workplaces overrun by abusive supervision, and are more likely to thrive under abusive bosses, being more resistant to stress, including interpersonal abuse, and having less of a need for positive relationships than others.<ref>{{Cite news |url=https://www.theladders.com/career-advice/the-surprising-sign-you-may-be-a-psychopath |title=If you're succeeding under a bully boss, you may be a psychopath |work=Ladders {{!}} Business News & Career Advice |access-date=2018-02-16 |url-status=live |archive-url=https://web.archive.org/web/20180216084912/https://www.theladders.com/career-advice/the-surprising-sign-you-may-be-a-psychopath |archive-date=2018-02-16}}</ref><ref name=":10">{{Cite news |url=https://www.sciencedaily.com/releases/2018/01/180123171433.htm |title=Flourishing under an abusive boss? You may be a psychopath, study shows |work=ScienceDaily |access-date=2018-02-16 |url-status=live |archive-url=https://web.archive.org/web/20180216204426/https://www.sciencedaily.com/releases/2018/01/180123171433.htm|archive-date=2018-02-16}}</ref><ref name=":11">{{Cite news |url=http://www.businessinsider.com/psychopaths-thrive-under-abusive-bosses-2018-1 |title=An abusive boss is bad news for your work life — unless you're a psychopath |work=] |access-date=2018-02-16 |url-status=live |archive-url=https://web.archive.org/web/20180216204459/http://www.businessinsider.com/psychopaths-thrive-under-abusive-bosses-2018-1 |archive-date=2018-02-16}}</ref>

=== In fiction ===
{{Main|Fictional portrayals of psychopaths}}

Characters with psychopathy or ] are some of the most notorious characters in film and literature, but their ] may only vaguely or partly relate to the concept of psychopathy as it is defined in ], ], and research. The character may be identified as having psychopathy within the fictional work itself, by its creators, or from the opinions of audiences and ], and may be based on undefined popular stereotypes of psychopathy.<ref name=":8">{{cite web |last1=Neumann |first1=Craig S. |title=Will the Real Psychopath Please Stand Up?|url=https://research.unt.edu/research-profiles/will-real-psychopath-please-stand |website=research.unt.edu |publisher=] |access-date=23 April 2016 |url-status=live |archive-url=https://web.archive.org/web/20160508143016/https://research.unt.edu/research-profiles/will-real-psychopath-please-stand |archive-date=8 May 2016}}</ref> Characters with psychopathic traits have appeared in ] and ], ] stories, and some of ]'s works.<ref name=":1">{{Cite book |title=The SAGE Encyclopedia of Abnormal and Clinical Psychology |publisher=] |year=2017 |isbn=978-1-4833-6582-4 |editor-last=Wenzel |editor-first=Amy |location=Thousand Oaks, California |pages=2744 |oclc=982958263}}</ref>

Such characters are often portrayed in an ] fashion and typically in the role of a ] or ], where the general characteristics and stereotypes associated with psychopathy are useful to facilitate conflict and danger. Because the definitions, criteria, and popular conceptions throughout ] have varied over the years and continue to change even now, many of the characters characterized as psychopathic in notable works at the time of publication may no longer fit the current definition and conception of psychopathy. There are several ] images of psychopathy in both lay and professional accounts which only partly overlap and can involve contradictory traits: the charming ], the deranged ] and ]er, the ], and the chronic low-level ] and ]. The public concept reflects some combination of fear of a mythical ], the disgust and intrigue surrounding ], and fascination and sometimes perhaps ] of people who might appear to go through life without ] and unencumbered by ], ] or ].<ref name="gap" />


== See also == == See also ==
* ]
* ]
* ]
* ]
* ] * ]
* ] *]


== References == == References ==
{{reflist}} {{reflist}}


== Further reading == == Bibliography ==
{{refbegin|40em}}
*{{cite book
* {{cite book |last1=Babiak |first1=Paul |last2=Hare |first2=Robert D. |url=https://archive.org/details/isbn_9780061147890 |url-access=registration |quote=snakes in suits. |title=Snakes in Suits: When Psychopaths Go to Work |publisher=] |location=New York, NY |isbn=978-0-06-114789-0 |date=2009-10-13}}
| last =Cleckley, M.D.
* Black, Will (2014) ''Psychopathic Cultures and Toxic Empires'' Frontline Noir, Edinburgh {{ISBN|978-1904684718}}
| first =Hervey
* Blair, J. et al. (2005) ''The Psychopath – Emotion and the Brain''. Malden, MA: Blackwell Publishing, {{ISBN|978-0-631-23335-0}}
| authorlink =
* {{Cite book |last=Cleckley |first=Hervey |title=The Mask of Sanity |publisher=Emily S. Cleckley |year=1988 |isbn=0-9621519-0-4 |location=Augusta, Georgia |url=https://archive.org/details/0490-pdf-cleckley-the-mask-of-sanity |edition=5th}}
| coauthors =
* ] (2012) ''The Wisdom of Psychopaths'' {{ISBN|978-0-374-70910-5}} (e-book)
| title =The Mask of Sanity
* {{cite book |last=Hare |first=Robert D. |author-link=Robert D. Hare |title=Without Conscience: The Disturbing World of the Psychopaths Among Us |publisher=] |location=New York |year=1999 |isbn=978-1-57230-451-2|url=https://archive.org/details/withoutconscienc00hare}}
| publisher =Mosbey Medical Library
* Häkkänen-Nyholm, H. & Nyholm, J-O. (2012). Psychopathy and Law: A Practitioners Guide. Chichester: John Wiley & Sons.
| date =1982
* {{cite book |last=Kiehl |first=Kent |author-link=Kent Kiehl |title=The psychopath whisperer: the science of those without a conscience |publisher=Crown Publishers |location=New York |year=2014 |isbn=978-0-7704-3584-4 }}
| location =
* ], Prometheus Books, Amherst, NY, 2007, {{ISBN|1-59102-665-2}}.
| pages = 7
* Stone, Michael H., M.D. & Brucato, Gary, Ph.D., The New Evil: Understanding the Emergence of Modern Violent Crime (Amherst, N.Y.: Prometheus Books). {{ISBN|978-1-63388-532-5}}.
| edition = Revised
* Thiessen, W Slip-ups and the dangerous mind: Seeing through and living beyond the psychopath (2012).
| url =
* Thimble, Michael H.F.R.C.P., F.R.C. Psych. ''Psychopathology of Frontal Lobe Syndromes''.
| doi =
* {{cite book |last=Widiger |first=Thomas |title=Personality Disorder Interview-IV, Chapter 4: Antisocial Personality Disorder |publisher=Psychological Assessment Resources, Inc. |year=1995 |isbn=978-0-911907-21-6}}
| id =
{{refend}}
| isbn = 0-452-25341-1}}
*] '' An Attempt to Reinterpret the So-Called Psychopathic Personality'', 5th Edition, revised 1984, PDF file download.
* {{cite journal |author=Cooke DJ, Michie C |title=Refining the construct of psychopathy: towards a hierarchical model |journal=Psychological assessment |volume=13 |issue=2 |pages=171-88 |year=2001 |pmid=11433793 |doi=}}
*] ''Without Conscience''.
*] with Paul Babiak '']'' (])
* {{cite journal |author=Hill CD, Neumann CS, Rogers R |title=Confirmatory factor analysis of the psychopathy checklist: screening version in offenders with axis I disorders |journal=Psychological assessment |volume=16 |issue=1 |pages=90-5 |year=2004 |pmid=15023097 |doi=10.1037/1040-3590.16.1.90}}
* {{cite journal |author=Neumann CS, Vitacco MJ, Hare RD, Wupperman P |title=Reconstruing the "reconstruction" of psychopathy: a comment on Cooke, Michie, Hart, and Clark |journal=J. Personal. Disord. |volume=19 |issue=6 |pages=624-40 |year=2005 |pmid=16553559 |doi=10.1521/pedi.2005.19.6.624}}
* Patrick, Christopher J. (2006) Handbook of Psychopathy.
* Michael H. Thimble, F.R.C.P., F.R.C. Psych. ''Psychopathology of Frontal Lobe Syndromes''.


== External links == == External links ==
{{Medical resources
| DiseasesDB =
| ICD9 =
| OMIM =
| MedlinePlus = 000921
| MeSH = D000987
}}
{{Commons category}}
{{Wiktionary}} {{Wiktionary}}
{{wikiquote}}
*
* on Google Books.
* Official web site for Dr. Robert Hare
* , PDF of Hervey Cleckley's book, 1988
* Malatesti, L,
* Official web site of Robert Hare
* O'Connor, T,
*
* RCMP Gazette Vol. 66, Issue 3 2004,
* *
*
*
* {{Webarchive|url=https://web.archive.org/web/20130415015241/http://www.psychiatrictimes.com/display/article/10168/54411 |date=2013-04-15 }} Psychiatric Times, 2007 (nb: inconsistent access)
]
* ''Nature'', 2001
]
* {{cite news |url=https://www.npr.org/2011/05/26/136619689/can-a-test-really-tell-whos-a-psychopath |title=Can A Test Really Tell Who's A Psychopath? |website=npr.org |publisher=] |quote=NPR audio, text and expert panel report, 2011}}
* '']'', October 2012
* in ''The Atlantic''

{{Misinformation}}
{{Psychopathy}}
{{abuse}}

{{Authority control}}


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Latest revision as of 04:19, 14 December 2024

Mental health disorder Not to be confused with Psychosis, Psychopathology, Psychic, or Sycophancy. "Psychopaths" and "Psychopath" redirect here. For other uses, see Psychopath (disambiguation). "Sociopathy" and "Sociopath" redirect here. For another usage of these terms, see antisocial personality disorder.

Medical condition
Psychopathy
Pronunciation
SpecialtyPsychiatry, clinical psychology, criminology
SymptomsBoldness, superficial charm, disinhibition, lack of empathy or remorse, inclination to violence and psychological manipulation, impulsivity, narcissism
CausesGenetic factors, low drive for affiliation, experiencing neglect or maltreatment
Risk factorsFamily history, fearless temperament, experiencing neglect or maltreatment
Differential diagnosisAntisocial personality disorder, narcissistic personality disorder, sexual sadism disorder, psychosis, other psychotic disorders such as schizophrenia, schizotypal disorder, schizoaffective disorder
PreventionProper care of children
TreatmentForms of psychotherapy including schema therapy for adults and parent management training for children
MedicationNone
PrognosisPoor

Psychopathy, or psychopathic personality, is a personality construct characterized by impaired empathy and remorse, in combination with traits of boldness, disinhibition, and egocentrism. These traits are often masked by superficial charm and immunity to stress, which create an outward appearance of feigned normalcy.

Hervey M. Cleckley, an American psychiatrist, influenced the initial diagnostic criteria for antisocial personality reaction/disturbance in the Diagnostic and Statistical Manual of Mental Disorders (DSM), as did American psychologist George E. Partridge. The DSM and International Classification of Diseases (ICD) subsequently introduced the diagnoses of antisocial personality disorder (ASPD) and dissocial personality disorder (DPD) respectively, stating that these diagnoses have been referred to (or include what is referred to) as psychopathy or sociopathy. The creation of ASPD and DPD was driven by the fact that many of the classic traits of psychopathy were impossible to measure objectively. Canadian psychologist Robert D. Hare later re-popularized the construct of psychopathy in criminology with his Psychopathy Checklist.

Although no psychiatric or psychological organization has sanctioned a diagnosis titled "psychopathy", assessments of psychopathic characteristics are widely used in criminal justice settings in some nations and may have important consequences for individuals. The study of psychopathy is an active field of research. The term is also used by the general public, popular press, and in fictional portrayals. While the abbreviated term "psycho" is often employed in common usage in general media along with "crazy", "insane", and "mentally ill", there is a categorical difference between psychosis and psychopathy.

Signs and symptoms

Socially, psychopathy typically involves extensive callous and manipulative self-serving behaviors with no regard for others and often is associated with repeated delinquency, crime, and violence. Mentally, impairments in processes related to affect and cognition, particularly socially related mental processes, have also been found. Developmentally, symptoms of psychopathy have been identified in young children with conduct disorder and suggest at least a partial constitutional factor that influences its development.

Primary features

Disagreement exists over which features should be considered as part of psychopathy, with researchers identifying around 40 traits supposedly indicative of the construct, though the following characteristics are almost universally considered central.

Core traits

Cooke and Michie (2001) proposed a three-factor model of the Psychopathy Checklist-Revised which has seen widespread application in other measures (e.g., Youth Psychopathic Traits Inventory, Antisocial Process Screening Device).

  • Arrogant and deceitful interpersonal style: impression management or superficial charm, inflated and grandiose sense of self-worth, pathological lying/deceit, and manipulation for personal gain.
  • Deficient affective experience: lack of remorse or guilt, shallow affect (coldness and unemotionality), callousness and lack of empathy, and failure to accept responsibility for own actions.
  • Impulsive and irresponsible lifestyle: impulsivity, sensation-seeking and risk-taking, irresponsible and unreliable behavior, financially parasitic lifestyle, and a lack of realistic, long-term goals.

Low anxiety and fearlessness

Cleckley's (1941) original description of psychopathy included the absence of nervousness and neurotic disorders, and later theorists referred to psychopaths as fearless or thick-skinned. While it is often claimed that the PCL-R does not include low anxiety or fearlessness, such features do contribute to the scoring of the Facet 1 (interpersonal) items, mainly through self-assurance, unrealistic optimism, brazenness, and imperturbability. Indeed, while self-report studies have been inconsistent using the two-factor model of the PCL-R, studies which separate Factor 1 into interpersonal and affective facets, more regularly show modest associations between Facet 1 and low anxiety, boldness and fearless dominance (especially items assessing glibness/charm and grandiosity). When both psychopathy and low anxiety/boldness are measured using interviews, both interpersonal and affective facets are both associated with fearlessness and lack of internalizing disorders.

The importance of low anxiety/fearlessness to psychopathy has historically been underscored through behavioral and physiological studies showing diminished responses to threatening stimuli (interpersonal and affective facets both contributing). However, it is not known whether this is reflected in the reduced experience of state fear or where it reflects impaired detection and response to threat-related stimuli. Moreover, such deficits in threat responding are known to be reduced or even abolished when attention is focused on the threatening stimuli.

Offending

Criminality

Psychopathy is strongly correlated with crime, violence, and antisocial behavior.

In terms of simple correlations, the PCL-R manual states an average score of 22.1 has been found in North American prisoner samples, and that 20.5% scored 30 or higher. An analysis of prisoner samples from outside North America found a somewhat lower average value of 17.5. Studies have found that psychopathy scores correlated with repeated imprisonment, detention in higher security, disciplinary infractions, and substance misuse.

Psychopathy, as measured with the PCL-R in institutional settings, shows in meta-analyses small to moderate effect sizes with institutional misbehavior, postrelease crime, or postrelease violent crime with similar effects for the three outcomes. Individual studies give similar results for adult offenders, forensic psychiatric samples, community samples, and youth. The PCL-R is poorer at predicting sexual re-offending. This small to moderate effect appears to be due largely to the scale items that assess impulsive behaviors and past criminal history, which are well-established but very general risk factors. The aspects of core personality often held to be distinctively psychopathic generally show little or no predictive link to crime by themselves. For example, Factor 1 of the PCL-R and Fearless dominance of the PPI-R have a smaller or no relationship to crime, including violent crime. In contrast, Factor 2 and Impulsive antisociality of the PPI-R are associated more strongly with criminality. Factor 2 has a relationship of similar strength to that of the PCL-R as a whole. The antisocial facet of the PCL-R is still predictive of future violence after controlling for past criminal behavior which, together with results regarding the PPI-R which by design does not include past criminal behavior, suggests that impulsive behaviors is an independent risk factor. Thus, the concept of psychopathy may perform poorly when attempted to be used as a general theory of crime.

Violence

Studies have suggested a strong correlation between psychopathy scores and violence, and the PCL-R emphasizes features that are somewhat predictive of violent behavior. Researchers, however, have noted that psychopathy is dissociable from and not synonymous with violence.

It has been suggested that psychopathy is associated with "instrumental aggression", also known as predatory, proactive, or "cold-blooded" aggression, a form of aggression characterized by reduced emotion and conducted with a goal differing from but facilitated by the commission of harm. One conclusion in this regard was made by a 2002 study of homicide offenders, which reported that the homicides committed by homicidal offenders with psychopathy were almost always (93.3%) primarily instrumental, significantly more than the proportion (48.4%) of those committed by non-psychopathic homicidal offenders, with the instrumentality of the homicide also correlated with the total PCL-R score of the offender as well as their scores on the Factor 1 "interpersonal-affective" dimension. However, contrary to the equating of this to mean exclusively "in cold blood", more than a third of the homicides committed by psychopathic offenders involved some component of emotional reactivity as well. In any case, FBI profilers indicate that serious victim injury is generally an emotional offense, and some research supports this, at least concerning sexual offending. One study has found more serious offending by non-psychopathic offenders on average than by offenders with psychopathy (e.g. more homicides versus more armed robbery and property offenses) and another that the Affective facet of the PCL-R predicted reduced offense seriousness.

Studies on perpetrators of domestic violence find that abusers have high rates of psychopathy, with the prevalence estimated to be at around 15-30%. Furthermore, the commission of domestic violence is correlated with Factor 1 of the PCL-R, which describes the emotional deficits and the callous and exploitative interpersonal style found in psychopathy. The prevalence of psychopathy among domestic abusers indicate that the core characteristics of psychopathy, such as callousness, remorselessness, and a lack of close interpersonal bonds, predispose those with psychopathy to committing domestic abuse, and suggest that the domestic abuses committed by these individuals are callously perpetrated (i.e. instrumentally aggressive) rather than a case of emotional aggression and therefore may not be amenable to the types of psychosocial interventions commonly given to domestic abuse perpetrators.

Some clinicians suggest that assessment of the construct of psychopathy does not necessarily add value to violence risk assessment. A large systematic review and meta-regression found that the PCL performed the poorest out of nine tools for predicting violence. In addition, studies conducted by the authors or translators of violence prediction measures, including the PCL, show on average more positive results than those conducted by more independent investigators. Several other risk assessment instruments can predict further crime with an accuracy similar to the PCL-R and some of these are considerably easier, quicker, and less expensive to administer. This may even be done automatically by a computer simply based on data such as age, gender, number of previous convictions, and age of first conviction. Some of these assessments may also identify treatment changes and goals, identify quick changes that may help short-term management, identify more specific kinds of violence that may be at risk, and establish specific probabilities of offending for specific scores. Nonetheless, the PCL-R may continue to be popular for risk assessment because of its pioneering role and the large amount of research done using it.

The U.S. Federal Bureau of Investigation (FBI) reports that psychopathic behavior is consistent with traits common to some serial killers, including sensation seeking, a lack of remorse or guilt, impulsivity, the need for control, and predatory behavior. It has also been found that the homicide victims of psychopathic offenders were disproportionately female in comparison to the more equitable gender distribution of victims of non-psychopathic offenders.

Sexual offending

Psychopathy has been associated with the commission of sexual crime, with some researchers arguing that it is correlated with a preference for violent sexual behavior. A 2011 study of conditional releases for Canadian male federal offenders found that psychopathy was related to more violent and non-violent offences but not more sexual offences. For child molesters, psychopathy was associated with more offences. A study on the relationship between psychopathy scores and types of aggression in a sample of sexual murderers, in which 84.2% of the sample had PCL-R scores above 20 and 47.4% above 30, found that 82.4% of those with scores above 30 had engaged in sadistic violence (defined as enjoyment indicated by self-report or evidence) compared to 52.6% of those with scores below 30, and total PCL-R and Factor 1 scores correlated significantly with sadistic violence. Despite this, it is reported that offenders with psychopathy (both sexual and non-sexual offenders) are about 2.5 times more likely to be granted conditional release compared to non-psychopathic offenders.

Hildebrand and colleagues (2004) have uncovered an interaction between psychopathy and deviant sexual interests, wherein those high in psychopathy who also endorsed deviant sexual interests were more likely to recidivate sexually. A subsequent meta-analysis has consolidated such a result.

In considering the issue of possible reunification of some sex offenders into homes with a non-offending parent and children, it has been advised that any sex offender with a significant criminal history should be assessed on the PCL-R, and if they score 18 or higher, then they should be excluded from any consideration of being placed in a home with children under any circumstances. There is, however, increasing concern that PCL scores are too inconsistent between different examiners, including in its use to evaluate sex offenders.

Other offending

See also: § In the workplace

The possibility of psychopathy has been associated with organized crime, economic crime, and war crimes. Terrorists are sometimes considered psychopathic, and comparisons may be drawn with traits such as antisocial violence, a selfish worldview that precludes the welfare of others, a lack of remorse or guilt, and blame externalization. However, John Horgan, author of The Psychology of Terrorism, argues that such comparisons could also then be drawn more widely: for example, to soldiers in wars. Coordinated terrorist activity requires organization, loyalty, and ideological fanaticism often to the extreme of sacrificing oneself for an ideological cause. Traits such as a self-centered disposition, unreliability, poor behavioral controls, and unusual behaviors may disadvantage or preclude psychopathic individuals from conducting organized terrorism.

It may be that a significant portion of people with psychopathy are socially successful and tend to express their antisocial behavior through more covert avenues such as social manipulation or white collar crime. Such individuals are sometimes referred to as "successful psychopaths", and may not necessarily always have extensive histories of traditional antisocial behavior as characteristic of traditional psychopathy.

Childhood and adolescent precursors

The PCL:YV is an adaptation of the PCL-R for individuals aged 13–18 years. It is, like the PCL-R, done by a trained rater based on an interview and an examination of criminal and other records. The "Antisocial Process Screening Device" (APSD) is also an adaptation of the PCL-R. It can be administered by parents or teachers for individuals aged 6–13 years. High psychopathy scores for both juveniles (as measured with these instruments) and adults (as measured with the PCL-R and other measurement tools) have similar associations with other variables, including similar ability in predicting violence and criminality. Juvenile psychopathy may also be associated with more negative emotionality such as anger, hostility, anxiety, and depression. Psychopathic traits in youth typically comprise three factors: callous/unemotional, narcissism, and impulsivity/irresponsibility.

There is a positive correlation between early negative life events of the ages 0–4 and the emotion-based aspects of psychopathy. There are moderate to high correlations between psychopathy rankings from late childhood to early adolescence. The correlations are considerably lower from early- or mid-adolescence to adulthood. In one study most of the similarities were on the Impulsive- and Antisocial-Behavior scales. Of those adolescents who scored in the top 5% highest psychopathy scores at age 13, less than one-third (29%) were classified as psychopathic at age 24. Some recent studies have also found a poorer ability to predict long-term, adult offending.

Conduct disorder

Main article: Conduct disorder

Conduct disorder is diagnosed based on a prolonged pattern of antisocial behavior in childhood and/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. The DSM allows differentiating between childhood onset before age 10 and adolescent onset at age 10 and later. Childhood-onset is argued to be more due to a personality disorder caused by neurological deficits interacting with an adverse environment. For many, but not all, childhood onset is associated with what is in Terrie Moffitt's developmental theory of crime referred to as "life-course- persistent" antisocial behavior as well as poorer health and economic status. Adolescent onset is argued to more typically be associated with short-term antisocial behavior.

It has been suggested that the combination of early-onset conduct disorder and ADHD may be associated with life-course-persistent antisocial behaviors as well as psychopathy. There is evidence that this combination is more aggressive and antisocial than those with conduct disorder alone. However, it is not a particularly distinct group since the vast majority of young children with conduct disorder also have ADHD. Some evidence indicates that this group has deficits in behavioral inhibition, similar to that of adults with psychopathy. They may not be more likely than those with conduct disorder alone to have the interpersonal/affective features and the deficits in emotional processing characteristic of adults with psychopathy. Proponents of different types/dimensions of psychopathy have seen this type as possibly corresponding to adult secondary psychopathy and increased disinhibition in the triarchic model.

The DSM-5 includes a specifier for those with conduct disorder who also display a callous, unemotional interpersonal style across multiple settings and relationships. The specifier is based on research that suggests that those with conduct disorder who also meet the criteria for the specifier tend to have a more severe form of the disorder with an earlier onset as well as a different response to treatment. Proponents of different types/dimensions of psychopathy have seen this as possibly corresponding to adult primary psychopathy and increased boldness and/or meanness in the triarchic model.

Mental traits

Cognition

Dysfunctions in the prefrontal cortex and amygdala regions of the brain have been associated with specific learning impairments in psychopathy. Damage to the ventromedial prefrontal cortex, which regulates the activity in the amygdala, leads to common characteristics in psychopathic individuals. Since the 1980s, scientists have linked traumatic brain injury, including damage to these regions, with violent and psychopathic behavior. Patients with damage in such areas resembled "psychopathic individuals" whose brains were incapable of acquiring social and moral knowledge; those who acquired damage as children may have trouble conceptualizing social or moral reasoning, while those with adult-acquired damage may be aware of proper social and moral conduct but be unable to behave appropriately. Dysfunctions in the amygdala and ventromedial prefrontal cortex may also impair stimulus-reinforced learning in psychopaths, whether punishment-based or reward-based. People scoring 25 or higher in the PCL-R, with an associated history of violent behavior, appear to have significantly reduced mean microstructural integrity in their uncinate fasciculuswhite matter connecting the amygdala and orbitofrontal cortex. There is evidence from DT-MRI of breakdowns in the white matter connections between these two important areas.

Although some studies have suggested inverse relationships between psychopathy and intelligence, including with regards to verbal IQ, Hare and Neumann state that a large literature demonstrates at most only a weak association between psychopathy and IQ, noting that the early pioneer Cleckley included good intelligence in his checklist due to selection bias (since many of his patients were "well educated and from middle-class or upper-class backgrounds") and that "there is no obvious theoretical reason why the disorder described by Cleckley or other clinicians should be related to intelligence; some psychopaths are bright, others less so". Studies also indicate that different aspects of the definition of psychopathy (e.g. interpersonal, affective (emotion), behavioral, and lifestyle components) can show different links to intelligence, and the result can depend on the type of intelligence assessment (e.g. verbal, creative, practical, analytical).

Emotion recognition and empathy

A large body of research suggests that psychopathy is associated with atypical responses to distress cues from other people, more precisely an impaired emotional empathy in the recognition of, and response to, facial expressions, body gestures and vocal tones of fear, sadness, pain and happiness. This impaired recognition and reduced autonomic responsiveness might be partly accounted for by a decreased activation of the fusiform and extrastriate cortical regions. The underlying biological surfaces for processing expressions of happiness are functionally intact in psychopaths, although less responsive than those of controls. The neuroimaging literature is unclear as to whether deficits are specific to particular emotions such as fear. The overall pattern of results across studies indicates that people diagnosed with psychopathy demonstrate reduced MRI, fMRI, aMRI, PET, and SPECT activity in areas of the brain. Research has also shown that an approximate 18% smaller amygdala size contributes to a significantly lower emotional sensation in regards to fear, sadness, amongst other negative emotions, which may likely be the reason as to why psychopathic individuals have lower empathy. Some recent fMRI studies have reported that emotion perception deficits in psychopathy are pervasive across emotions (positives and negatives). Studies on children with psychopathic tendencies have also shown such associations. Meta-analyses have also found evidence of impairments in both vocal and facial emotional recognition for several emotions (i.e., not only fear and sadness) in both adults and children/adolescents.

Moral judgment

Psychopathy has been associated with amorality—an absence of, indifference towards, or disregard for moral beliefs. There are few firm data on patterns of moral judgment. Studies of the developmental level (sophistication) of moral reasoning found all possible results—lower, higher or the same as non-psychopaths. Studies that compared judgments of personal moral transgressions versus judgments of breaking conventional rules or laws found that psychopaths rated them as equally severe, whereas non-psychopaths rated the rule-breaking as less severe.

A study comparing judgments of whether personal or impersonal harm would be endorsed to achieve the rational maximum (utilitarian) amount of welfare found no significant differences between subjects high and low in psychopathy. However, a further study using the same tests found that prisoners scoring high on the PCL were more likely to endorse impersonal harm or rule violations than non-psychopathic controls were. The psychopathic offenders who scored low in anxiety were also more willing to endorse personal harm on average.

Assessing accidents, where one person harmed another unintentionally, psychopaths judged such actions to be more morally permissible. This result has been considered a reflection of psychopaths' failure to appreciate the emotional aspect of the victim's harmful experience.

History

Main article: History of psychopathy

Etymology

The word psychopathy is a joining of the Greek words psyche (ψυχή) "soul" and pathos (πάθος) "suffering, feeling". The first documented use is from 1847 in Germany as psychopatisch, and the noun psychopath has been traced to 1885. In medicine, patho- has a more specific meaning of disease (Thus pathology has meant the study of disease since 1610, and psychopathology has meant the study of mental disorder in general since 1847. A sense of "a subject of pathology, morbid, excessive" is attested from 1845, including the phrase pathological liar from 1891 in the medical literature).

The term psychopathy initially had a very general meaning referring to all sorts of mental disorders and social aberrations, popularised from 1891 in Germany by Koch's concept of "psychopathic inferiority" (psychopathische Minderwertigkeiten). Some medical dictionaries still define psychopathy in both a narrow and broad sense, such as MedlinePlus from the U.S. National Library of Medicine. On the other hand, Stedman's Medical Dictionary defines "psychopath" only as a "former designation" for a person with an antisocial type of personality disorder.

The term psychosis was also used in Germany from 1841, originally in a very general sense. The suffix -ωσις (-osis) meant in this case "abnormal condition". This term or its adjective psychotic would come to refer to the more severe mental disturbances and then specifically to mental states or disorders characterized by hallucinations, delusions, or in some other sense markedly out of touch with reality.

The slang term psycho has been traced to a shortening of the adjective psychopathic from 1936, and from 1942 as a shortening of the noun psychopath, but it is also used as shorthand for psychotic or crazed.

The media usually uses the term psychopath to designate any criminal whose offenses are particularly abhorrent and unnatural, but that is not its original or general psychiatric meaning.

Sociopathy

The word element socio- has been commonly used in compound words since around 1880. The term sociopathy may have been first introduced in 1909 in Germany by biological psychiatrist Karl Birnbaum and in 1930 in the US by educational psychologist George E. Partridge, as an alternative to the concept of psychopathy. It was used to indicate that the defining feature is violation of social norms, or antisocial behavior, and may be social or biological in origin.

The terms sociopathy and psychopathy were once used interchangeably concerning antisocial personality disorder, though this usage is outdated in medicine and psychiatry. Psychopathy, however, is a highly popular construct in the psychology literature. Furthermore, the DSM-5 introduced the dimensional model of personality disorders in Section III, which includes a specifier for psychopathic traits. According to the DSM, psychopathy is not a standalone diagnosis, but the authors attempted to measure "psychopathic traits" via a specifier. In one study, the "Psychopathic Features Specifier" has been modeled on Factor 1 of the Psychopathic Personality Inventory, known as Fearless Dominance. To some, it is evidence of psychopathy not being a more extreme version of ASPD, but as an emergent compound trait that manifests when Antisocial Personality Disorder is present in combination with high levels of Fearless Dominance (or Boldness as it's known in the Triarchic Model). Analyses showed that this Section III ASPD greatly outperformed Section II ASPD in predicting scores on Hare’s (2003) Psychopathy Checklist-Revised.

Section III ASPD including the 'Psychopathic Traits Specifier' can be seen on page 765 of the DSM-5 or Page 885 of the DSM-5-TR.

The term is used in various ways in contemporary usage. Robert Hare stated in the popular science book Snakes in Suits that sociopathy and psychopathy are often used interchangeably, but in some cases the term sociopathy is preferred because it is less likely than is psychopathy to be confused with psychosis, whereas in other cases the two terms may be used with different meanings that reflect the user's views on its origins and determinants. Hare contended that the term sociopathy is preferred by those who see the causes as due to social factors and early environment, and the term psychopathy is preferred by those who believe that there are psychological, biological, and genetic factors involved in addition to environmental factors. Hare also provides his own definitions: he describes psychopathy as lacking a sense of empathy or morality, but sociopathy as only differing from the average person in the sense of right and wrong.

Precursors

Ancient writings that have been connected to psychopathic traits include Deuteronomy 21:18–21 and a description of an unscrupulous man by the Greek philosopher Theophrastus around 300 BC.

The concept of psychopathy has been indirectly connected to the early 19th-century work of Pinel (1801; "mania without delirium") and Pritchard (1835; "moral insanity"), although historians have largely discredited the idea of a direct equivalence. Psychopathy originally described any illness of the mind, but found its application to a narrow subset of mental conditions when it was used toward the end of the 19th century by the German psychiatrist Julius Koch (1891) to describe various behavioral and moral dysfunction in the absence of an obvious mental illness or intellectual disability. He applied the term psychopathic inferiority (psychopathischen Minderwertigkeiten) to various chronic conditions and character disorders, and his work would influence the later conception of the personality disorder.

The term psychopathic came to be used to describe a diverse range of dysfunctional or antisocial behavior and mental and sexual deviances, including at the time homosexuality. It was often used to imply an underlying "constitutional" or genetic origin. Disparate early descriptions likely set the stage for modern controversies about the definition of psychopathy.

20th century

An influential figure in shaping modern American conceptualizations of psychopathy was American psychiatrist Hervey Cleckley. In his classic monograph, The Mask of Sanity (1941), Cleckley drew on a small series of vivid case studies of psychiatric patients at a Veterans Administration hospital in Georgia to describe psychopathy. Cleckley used the metaphor of the "mask" to refer to the tendency of psychopaths to appear confident, personable, and well-adjusted compared to most psychiatric patients while revealing underlying pathology through their actions over time. Cleckley formulated sixteen criteria for psychopathy. The Scottish psychiatrist David Henderson had also been influential in Europe from 1939 in narrowing the diagnosis.

The diagnostic category of sociopathic personality in early editions of the Diagnostic and Statistical Manual (DSM) had some key similarities to Cleckley's ideas, though in 1980 when renamed Antisocial Personality Disorder some of the underlying personality assumptions were removed. In 1980, Canadian psychologist Robert D. Hare introduced an alternative measure, the "Psychopathy Checklist" (PCL) based largely on Cleckley's criteria, which was revised in 1991 (PCL-R), and is the most widely used measure of psychopathy. There are also several self-report tests, with the Psychopathic Personality Inventory (PPI) used more often among these in contemporary adult research.

Famous individuals have sometimes been diagnosed, albeit at a distance, as psychopaths. As one example out of many possible from history, in a 1972 version of a secret report originally prepared for the Office of Strategic Services in 1943, which may have been intended to be used as propaganda, non-medical psychoanalyst Walter C. Langer suggested Adolf Hitler was probably a psychopath. However, others have not drawn this conclusion; clinical forensic psychologist Glenn Walters argues that Hitler's actions do not warrant a diagnosis of psychopathy as, although he showed several characteristics of criminality, he was not always egocentric, callously disregarding of feelings or lacking impulse control, and there is no proof he could not learn from mistakes.

Definition

Concepts

Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and in feelings 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.

Robert D. Hare, 1993, p. xi

There are multiple conceptualizations of psychopathy, including Cleckleyan psychopathy (Hervey Cleckley's conception entailing bold, disinhibited behavior, and "feckless disregard") and criminal psychopathy (a meaner, more aggressive and disinhibited conception explicitly entailing persistent and sometimes serious criminal behavior). The latter conceptualization is typically used as the modern clinical concept and assessed by the Psychopathy Checklist. The label "psychopath" may have implications and stigma related to decisions about punishment severity for criminal acts, medical treatment, civil commitments, etc. Efforts have therefore been made to clarify the meaning of the term.

It has been suggested that those who share the same emotional deficiencies and psychopathic features, but are properly socialized, should not be designated as 'psychopaths'.

The triarchic model suggests that different conceptions of psychopathy emphasize three observable characteristics to various degrees. Analyses have been made with respect to the applicability of measurement tools such as the Psychopathy Checklist (PCL, PCL-R) and Psychopathic Personality Inventory (PPI) to this model.

  • Boldness. Low fear including stress-tolerance, toleration of unfamiliarity and danger, and high self-confidence and social assertiveness. The PCL-R measures this relatively poorly and mainly through Facet 1 of Factor 1. Similar to PPI fearless dominance. May correspond to differences in the amygdala and other neurological systems associated with fear.
  • Disinhibition. Poor impulse control including problems with planning and foresight, lacking affect and urge control, demand for immediate gratification, and poor behavioral restraints. Similar to PCL-R Factor 2 and PPI impulsive antisociality. May correspond to impairments in frontal lobe systems that are involved in such control.
  • Meanness. Lacking empathy and close attachments with others, disdain of close attachments, use of cruelty to gain empowerment, exploitative tendencies, defiance of authority, and destructive excitement seeking. The PCL-R in general is related to this but in particular some elements in Factor 1. Similar to PPI, but also includes elements of subscales in impulsive antisociality.

Psychopathy has been conceptualized as a hybrid condition marked by a paradoxical combination of superficial charm, poise, emotional resilience, and venturesomeness on the outside but deep-seated affective disturbances and impulse control deficits on the inside. From this perspective, psychopathy is at least in part characterized by psychologically adaptive traits. Furthermore, according to this view, psychopathy may be linked to at least some interpersonally successful outcomes, such as effective leadership, business accomplishments, and heroism.

Measurement

An early and influential analysis from Harris and colleagues indicated that a discrete category, or taxon, may underlie PCL-R psychopathy, allowing it to be measured and analyzed. However, this was only found for the behavioral Factor 2 items they identified, child problem behaviors; adult criminal behavior did not support the existence of a taxon. Marcus, John, and Edens more recently performed a series of statistical analyses on PPI scores and concluded that psychopathy may best be conceptualized as having a "dimensional latent structure" like depression.

Marcus et al. repeated the study on a larger sample of prisoners, using the PCL-R and seeking to rule out other experimental or statistical issues that may have produced the previously different findings. They again found that the psychopathy measurements do not appear to be identifying a discrete type (a taxon). They suggest that while for legal or other practical purposes an arbitrary cut-off point on trait scores might be used, there is actually no clear scientific evidence for an objective point of difference by which to label some people "psychopaths"; in other words, a "psychopath" may be more accurately described as someone who is "relatively psychopathic".

The PCL-R was developed for research, not clinical forensic diagnosis, and even for research purposes to improve understanding of the underlying issues, it is necessary to examine dimensions of personality in general rather than only a constellation of traits. The PCL-R test has been used to determine "true" or primary psychopaths (individuals that score a 30 or higher on the PCL-R test). Primary psychopaths are distinguished from secondary psychopaths, and contrast with those who are legitimately considered antisocial.

Personality dimensions

Studies have linked psychopathy to alternative dimensions such as antagonism (high), conscientiousness (low), and anxiousness (low).

Psychopathy has also been linked to high psychoticism—a theorized dimension referring to tough, aggressive, or hostile tendencies. Aspects of this that appear associated with psychopathy are lack of socialization and responsibility, impulsivity, sensation-seeking (in some cases), and aggression.

Otto Kernberg, from a particular psychoanalytic perspective, believed psychopathy should be considered as part of a spectrum of pathological narcissism, that would range from narcissistic personality on the low end, malignant narcissism in the middle, and psychopathy at the high end.

Psychopathy, narcissism, and Machiavellianism, three personality traits that are together referred to as the dark triad, share certain characteristics, such as a callous-manipulative interpersonal style. The dark tetrad refers to these traits with the addition of sadism. Several psychologists have asserted that subclinical psychopathy and Machiavellianism are more or less interchangeable. There is a subscale on the Psychopathic Personality Inventory (PPI) dubbed "Machiavellian Egocentricity". Delroy Paulhus has asserted that the difference that most miss is that while both are characterized by manipulativeness and unemotionality, psychopaths tend to be more reckless. One study asserted that "the ability to adapt, reappraise and reassess a situation may be key factors differentiating Machiavellianism from psychopathy, for example". Psychopathy and Machiavellianism were also correlated similarly in responses to affective stimuli, and both are negatively correlated with the recognition of facial emotions. Many have suggested merging the dark triad traits (especially Machiavellianism and psychopathy) into one construct, given empirical studies that show immense overlap.

Criticism of current conceptions

The current conceptions of psychopathy have been criticized for being poorly conceptualized, highly subjective, and encompassing a wide variety of underlying disorders. Dorothy Otnow Lewis has written:

The concept and subsequent reification of the diagnosis "psychopathy" has, to this author's mind, hampered the understanding of criminality and violence. According to Hare, in many cases one need not even meet the patient. Just rummage through his records to determine what items seemed to fit. Nonsense. To this writer's mind, psychopathy and its synonyms (e.g., sociopathy and antisocial personality) are lazy diagnoses. Over the years the authors' team has seen scores of offenders who, prior to evaluation by the authors, were dismissed as psychopaths or the like. Detailed, comprehensive psychiatric, neurological, and neuropsychological evaluations have uncovered a multitude of signs, symptoms, and behaviors indicative of such disorders as bipolar mood disorder, schizophrenia spectrum disorders, complex partial seizures, dissociative identity disorder, parasomnia, and, of course, brain damage/dysfunction.

Half of the Hare Psychopathy Checklist consists of symptoms of mania, hypomania, and frontal-lobe dysfunction, which frequently results in underlying disorders being dismissed. Hare's conception of psychopathy has also been criticized for being reductionist, dismissive, tautological, and ignorant of context as well as the dynamic nature of human behavior. Some have called for rejection of the concept altogether, due to its vague, subjective and judgmental nature that makes it prone to misuse. A systematic review determined that the PCL is weakly predictive of criminal behavior, but not of lack of conscience, or treatment and rehabilitation outcomes. These findings contradict widespread beliefs among professionals in forensics.

Psychopathic individuals do not show regret or remorse. This was thought to be due to an inability to generate this emotion in response to negative outcomes. However, in 2016, people with antisocial personality disorder were found to experience regret but did not use the regret to guide their choice in behavior. There was no lack of regret but a problem to think through a range of potential actions and estimating the outcome values.

In an experiment published in March 2007 at the University of Southern California neuroscientist Antonio R. Damasio and his colleagues showed that subjects with damage to the ventromedial prefrontal cortex lack the ability to empathically feel their way to moral answers, and that when confronted with moral dilemmas, these brain-damaged patients coldly came up with "end-justifies-the-means" answers, leading Damasio to conclude that the point was not that they reached immoral conclusions, but that when they were confronted by a difficult issue – in this case as whether to shoot down a passenger plane hijacked by terrorists before it hits a major city – these patients appear to reach decisions without the anguish that afflicts those with typically functioning brains. According to Adrian Raine, a clinical neuroscientist also at the University of Southern California, one of this study's implications is that society may have to rethink how it judges immoral people: "Psychopaths often feel no empathy or remorse. Without that awareness, people relying exclusively on reasoning seem to find it harder to sort their way through moral thickets. Does that mean they should be held to different standards of accountability?"

Cause

Behavioral genetic studies have identified potential genetic and non-genetic contributors to psychopathy, including influences on brain function. Proponents of the triarchic model believe that psychopathy results from the interaction of genetic predispositions and an adverse environment. What is adverse may differ depending on the underlying predisposition: for example, it is hypothesized that persons having high boldness may respond poorly to punishment but may respond better to rewards and secure attachments.

Genetic

Genetically informed studies of the personality characteristics typical of individuals with psychopathy have found moderate genetic (as well as non-genetic) influences. On the PPI, fearless dominance and impulsive antisociality were similarly influenced by genetic factors and uncorrelated with each other. Genetic factors may generally influence the development of psychopathy while environmental factors affect the specific expression of the traits that predominate. A study on a large group of children found more than 60% heritability for "callous-unemotional traits" and that conduct disorder among children with these traits has a higher heritability than among children without these traits.

Environment

From accidents such as the one of Phineas Gage, it is known that the prefrontal cortex plays an important role in moral behavior.

A study by Farrington of a sample of London males between ages 8 and 48 included studying which factors scored 10 or more on the PCL:SV at age 48. The strongest factors included having a convicted parent, being physically neglected, low involvement of the father with the boy, low family income, and coming from a disrupted family. Other significant factors included poor supervision, abuse, harsh discipline, large family size, delinquent siblings, young mothers, depressed mothers, low social class, and poor housing. There has also been an association between psychopathy and detrimental treatment by peers. However, it is difficult to determine the extent of an environmental influence on the development of psychopathy because of evidence of its strong heritability.

Brain injury

Researchers have linked head injuries with psychopathy and violence. Since the 1980s, scientists have associated traumatic brain injury, such as damage to the prefrontal cortex, including the orbitofrontal cortex, with psychopathic behavior and a deficient ability to make morally and socially acceptable decisions, a condition that has been termed "acquired sociopathy", or "pseudopsychopathy". Individuals with damage to the area of the prefrontal cortex known as the ventromedial prefrontal cortex show remarkable similarities to diagnosed psychopathic individuals, displaying reduced autonomic response to emotional stimuli, deficits in aversive conditioning, similar preferences in moral and economic decision making, and diminished empathy and social emotions like guilt or shame. These emotional and moral impairments may be especially severe when the brain injury occurs at a young age. Children with early damage in the prefrontal cortex may never fully develop social or moral reasoning and become "psychopathic individuals ... characterized by high levels of aggression and antisocial behavior performed without guilt or empathy for their victims". Additionally, damage to the amygdala may impair the ability of the prefrontal cortex to interpret feedback from the limbic system, which could result in uninhibited signals that manifest in violent and aggressive behavior.

Childhood trauma

This section is an excerpt from Influence of childhood trauma in psychopathy.
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The influence of childhood trauma on the development of psychopathy in adulthood remains an active research question. According to Hervey M. Cleckley, a psychopathic person is someone who is able to imitate a normal functioning person, while masking or concealing their lack of internal personality structure. This results in an internal disorder with recurrent deliberate and detrimental conduct. Despite presenting themselves as serious, bright, and charming, psychopathic people are unable to experience true emotions. Robert Hare's two factor model and Christopher Patrick's triarchic model have both been developed to better understand psychopathy; however, whether the root cause is primarily environmental or primarily genetic is still in question.

Psychopathy is a personality construct consisting of affective, interpersonal, and behavioral dimensions that begins in childhood and manifests as aggressive actions in early or late adolescence. Childhood trauma affects vulnerability to different forms of psychopathology and traits associated with it. Parental behaviors such as rejection, abuse, neglect or overprotection show some relationship with the development of detrimental psychopathic traits. Disinhibition mediates the relationship between physical abuse and two components of psychopathy (social deviation and affective interpersonal). Sexual abuse is directly correlated with the social deviation factor, and physical abuse is directly correlated with the affective interpersonal factor. Gender differences have also been observed in psychopathy. For example, psychopathic antisocial personality traits are more noticeable in males while histrionic personality traits are more evident in females. In addition, women are more likely to experience internalizing psychopathology than men and males may exhibit a stronger association between boldness and the experience of neglect as a child, as well as between meanness and the experience of childhood maltreatment.

Other theories

Evolutionary explanations

See also: Evolutionary psychiatry

Psychopathy is associated with several adverse life outcomes as well as an increased risk of disability and death due to factors such as violence, accidents, homicides, and suicides. This, in combination with the evidence for genetic influences, is evolutionarily puzzling and may suggest that there are compensating evolutionary advantages, and researchers within evolutionary psychology have proposed several evolutionary explanations. According to one hypothesis, some traits associated with psychopathy may be socially adaptive, and psychopathy may be a frequency-dependent, socially parasitic strategy, which may work as long as there is a large population of altruistic and trusting individuals, relative to the population of psychopathic individuals, to be exploited. It is also suggested that some traits associated with psychopathy such as early, promiscuous, adulterous, and coercive sexuality may increase reproductive success. Robert Hare has stated that many psychopathic males have a pattern of mating with and quickly abandoning women, and thereby have a high fertility rate, resulting in children that may inherit a predisposition to psychopathy.

Criticism includes that it may be better to look at the contributing personality factors rather than treat psychopathy as a unitary concept due to poor testability. Furthermore, if psychopathy is caused by the combined effects of a very large number of adverse mutations then each mutation may have such a small effect that it escapes natural selection. The personality is thought to be influenced by a very large number of genes and may be disrupted by random mutations, and psychopathy may instead be a product of a high mutation load. Psychopathy has alternatively been suggested to be a spandrel, a byproduct, or side-effect, of the evolution of adaptive traits rather than an adaptation in itself.

Mechanisms

Psychological

See also: § Mental characteristics

Some laboratory research demonstrates correlations between psychopathy and atypical responses to aversive stimuli, including weak conditioning to painful stimuli and poor learning of avoiding responses that cause punishment, as well as low reactivity in the autonomic nervous system as measured with skin conductance while waiting for a painful stimulus but not when the stimulus occurs. While it has been argued that the reward system functions normally, some studies have also found reduced reactivity to pleasurable stimuli. According to the response modulation hypothesis, psychopathic individuals have also had difficulty switching from an ongoing action despite environmental cues signaling a need to do so. This may explain the difficulty responding to punishment, although it is unclear if it can explain findings such as deficient conditioning. There may be methodological issues regarding the research. While establishing a range of idiosyncrasies on average in linguistic and affective processing under certain conditions, this research program has not confirmed a common pathology of psychopathy.

Neurological

Dysfunction of the orbitofrontal cortex, among other areas, is implicated in the mechanism of psychopathy.

Thanks to advancing MRI studies, experts can visualize specific brain differences and abnormalities of individuals with psychopathy in areas that control emotions, social interactions, ethics, morality, regret, impulsivity, and conscience within the brain. Blair, a researcher who pioneered research into psychopathic tendencies stated, "With regard to psychopathy, we have clear indications regarding why the pathology gives rise to the emotional and behavioral disturbance and important insights into the neural systems implicated in this pathology". Dadds et al., remarks that despite a rapidly advancing neuroscience of empathy, little is known about the developmental underpinnings of the psychopathic disconnect between affective and cognitive empathy.

A 2008 review by Weber et al. suggested that psychopathy is sometimes associated with brain abnormalities in prefrontal-temporo-limbic regions that are involved in emotional and learning processes, among others. Neuroimaging studies have found structural and functional differences between those scoring high and low on the PCL-R in a 2011 review by Skeem et al. stating that they are "most notably in the amygdala, hippocampus and parahippocampal gyri, anterior and posterior cingulate cortex, striatum, insula, and frontal and temporal cortex".

The amygdala and frontal areas have been suggested as particularly important. People scoring 25 or higher in the PCL-R, with an associated history of violent behavior, appear on average to have significantly reduced microstructural integrity between the white matter connecting the amygdala and orbitofrontal cortex (such as the uncinate fasciculus). The evidence suggested that the degree of abnormality was significantly related to the degree of psychopathy and may explain the offending behaviors. Furthermore, changes in the amygdala have been associated with "callous-unemotional" traits in children. However, the amygdala has also been associated with positive emotions, and there have been inconsistent results in the studies in particular areas, which may be due to methodological issues. Others have cast doubt on the amygdala as important for psychopathy, with one meta-analysis suggesting that most studies on the amygdala and psychopathy find no effect and that studies finding a negative effect (that psychopaths display less amygdala activity) have lower statistical power.

Some of these findings are consistent with other research and theories. For example, in a neuroimaging study of how individuals with psychopathy respond to emotional words, widespread differences in activation patterns have been shown across the temporal lobe when psychopathic criminals were compared to "normal" volunteers, which is consistent with views in clinical psychology. Additionally, the notion of psychopathy being characterized by low fear is consistent with findings of abnormalities in the amygdala, since deficits in aversive conditioning and instrumental learning are thought to result from amygdala dysfunction, potentially compounded by orbitofrontal cortex dysfunction, although the specific reasons are unknown.

Considerable research has documented the presence of the two subtypes of primary and secondary psychopathy. Proponents of the primary-secondary psychopathy distinction and triarchic model argue that there are neurological differences between these subgroups of psychopathy which support their views. For instance, the boldness factor in the triarchic model is argued to be associated with reduced activity in the amygdala during fearful or aversive stimuli and reduced startle response, while the disinhibition factor is argued to be associated with impairment of frontal lobe tasks. There is evidence that boldness and disinhibition are genetically distinguishable.

Biochemical

High levels of testosterone combined with low levels of cortisol and/or serotonin have been theorized as contributing factors. Testosterone is "associated with approach-related behavior, reward sensitivity, and fear reduction", and injecting testosterone "shift the balance from punishment to reward sensitivity", decreases fearfulness, and increases "responding to angry faces". Some studies have found that high testosterone levels are associated with antisocial and aggressive behaviors, yet other research suggests that testosterone alone does not cause aggression but increases dominance-seeking. It is unclear from studies if psychopathy correlates with high testosterone levels, but a few studies have found that disruption of serotonin neurotransmission disrupts cortisol reactivity to a stress-inducing speech task. Thus, dysregulation of serotonin in the brain may contribute to the low cortisol levels observed in psychopathy. Cortisol increases withdrawal behavior and sensitivity to punishment and aversive conditioning, which are abnormally low in individuals with psychopathy and may underlie their impaired aversion learning and disinhibited behavior. High testosterone levels combined with low serotonin levels are associated with "impulsive and highly negative reactions", and may increase violent aggression when an individual is provoked or becomes frustrated. Several animal studies note the role of serotonergic functioning in impulsive aggression and antisocial behavior.

However, some studies on animal and human subjects have suggested that the emotional-interpersonal traits and predatory aggression of psychopathy, in contrast to impulsive and reactive aggression, is related to increased serotoninergic functioning. A study by Dolan and Anderson, regarding the relationship between serotonin and psychopathic traits in a sample of personality disordered offenders, found that serotonin functioning as measured by prolactin response, while inversely associated with impulsive and antisocial traits, were positively correlated with arrogant and deceitful traits, and, to a lesser extent, callous and remorseless traits. Bariş Yildirim theorizes that the 5-HTTLPR "long" allele, which is generally regarded as protective against internalizing disorders, may interact with other serotoninergic genes to create a hyper-regulation and dampening of affective processes that results in psychopathy's emotional impairments. Furthermore, the combination of the 5-HTTLPR long allele and high testosterone levels has been found to result in a reduced response to threat as measured by cortisol reactivity, which mirrors the fear deficits found in those with psychopathy.

Studies have suggested other correlations. Psychopathy was associated in two studies with an increased ratio of HVA (a dopamine metabolite) to 5-HIAA (a serotonin metabolite). Studies have found that individuals with the traits meeting criteria for psychopathy show a greater dopamine response to potential "rewards" such as monetary promises or taking drugs such as amphetamines. This has been theoretically linked to increased impulsivity. A 2010 British study found that a large 2D:4D digit ratio, an indication of high prenatal estrogen exposure, was a "positive correlate of psychopathy in females, and a positive correlate of callous affect (psychopathy sub-scale) in males".

Findings have also shown monoamine oxidase A to affect the predictive ability of the PCL-R. Monoamine oxidases (MAOs) are enzymes that are involved in the breakdown of neurotransmitters such as serotonin and dopamine and are, therefore, capable of influencing feelings, mood, and behavior in individuals. Findings suggest that further research is needed in this area.

Diagnosis

Tools

Psychopathy Checklist

Main article: Psychopathy Checklist

Psychopathy is most commonly assessed with the Psychopathy Checklist, Revised (PCL-R), created by Robert D. Hare based on Cleckley's criteria from the 1940s, criminological concepts such as those of William and Joan McCord, and his own research on criminals and incarcerated offenders in Canada. The PCL-R is widely used and is referred to by some as the "gold standard" for assessing psychopathy. There are nonetheless numerous criticisms of the PCL-R as a theoretical tool and in real-world usage.

Psychopathic Personality Inventory

Main article: Psychopathic Personality Inventory

Unlike the PCL, the Psychopathic Personality Inventory (PPI) was developed to comprehensively index personality traits without explicitly referring to antisocial or criminal behaviors themselves. It is a self-report scale that was developed originally for non-clinical samples (e.g. university students) rather than prisoners, though may be used with the latter. It was revised in 2005 to become the PPI-R and now comprises 154 items organized into eight subscales. The item scores have been found to group into two overarching and largely separate factors (unlike the PCL-R factors), Fearless-Dominance and Impulsive Antisociality, plus a third factor, Coldheartedness, which is largely dependent on scores on the other two. Factor 1 is associated with social efficacy while Factor 2 is associated with maladaptive tendencies. A person may score at different levels on different factors, but the overall score indicates the extent of psychopathic personality.

Triarchic Psychopathy Measure

The Triarchic Psychopathy Measure, otherwise known as the TriPM, is a 58-item, self-report assessment that measures psychopathy within the three traits identified in the triarchic model: boldness, meanness, and disinhibition. Each trait is measured on separate subscales and added up resulting in a total psychopathy score.

The TriPM includes various components of other measures for assessing psychopathy, including meanness and disinhibition patterns within the psychopathic personality. However, there are differing approaches in the measurement of the boldness construct. The boldness construct is used to highlighting the social and interpersonal implications of the psychopathic personality.

DSM and ICD

There are currently two widely established systems for classifying mental disorders—the International Classification of Diseases (ICD) produced by the World Health Organization (WHO) and the Diagnostic and Statistical Manual of Mental Disorders (DSM) produced by the American Psychiatric Association (APA). Both list categories of disorders thought to be distinct types, and have deliberately converged their codes in recent revisions so that the manuals are often broadly comparable, although significant differences remain.

The first edition of the DSM in 1952 had a section on sociopathic personality disturbances, then a general term that included such things as homosexuality and alcoholism as well as an "antisocial reaction" and "dyssocial reaction". The latter two eventually became antisocial personality disorder (ASPD) in the DSM and dissocial personality disorder in the ICD. Both manuals have stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy, although neither diagnostic manual has ever included a disorder officially titled as such.

Other tools

There are some traditional personality tests that contain subscales relating to psychopathy, though they assess relatively non-specific tendencies towards antisocial or criminal behavior. These include the Minnesota Multiphasic Personality Inventory (Psychopathic Deviate scale), California Psychological Inventory (Socialization scale), and Millon Clinical Multiaxial Inventory Antisocial Personality Disorder scale. There is also the Levenson Self-Report Psychopathy Scale (LSRP) and the Hare Self-Report Psychopathy Scale (HSRP), but in terms of self-report tests, the PPI/PPI-R has become more used than either of these in modern psychopathy research on adults.

Comorbidity

Studies suggest strong comorbidity between psychopathy and antisocial personality disorder. Among numerous studies, positive correlations have also been reported between psychopathy and histrionic, narcissistic, borderline, paranoid, and schizoid personality disorders, panic and obsessive–compulsive disorders, but not neurotic disorders in general, schizophrenia, or depression.

Factor 1 and the boldness scale of psychopathy measurements are associated with narcissism and histrionic personality disorder. This is due to a psychopath's cognitive and affective egocentrism. However, while a narcissistic individual might view themselves as confident, they might seek out validation and attention from others to validate their self-worth, whereas a psychopathic individual usually lacks such ambitions.

Attention deficit hyperactivity disorder (ADHD) is known to be highly comorbid with conduct disorder (a theorized precursor to ASPD), and may also co-occur with psychopathic tendencies. This may be explained in part by deficits in executive function. Anxiety disorders often co-occur with ASPD, and contrary to assumptions, psychopathy can sometimes be marked by anxiety; this appears to be related to items from Factor 2 but not Factor 1 of the PCL-R. Psychopathy is also associated with substance use disorders.

Michael Fitzgerald suggested overlaps between (primary) psychopathy and Asperger syndrome in terms of fearlessness, planning of acts, empathy deficits, callous behaviour, and sometimes superficial charisma. Studies investigating similarities and differences between psychopathy and autism indicate that autism and psychopathy are not part of the same construct. Rather both conditions might co-occur in some individuals. Recent studies indicate that some individuals with an autism diagnosis also show callous and unemotional traits (a risk-factor for developing psychopathy), but are less strongly associated with conduct problems. Likewise, some people with Asperger syndrome have shown correlations with the "unemotional" factor and "behavioural dyscontrol" factor of psychopathy, but not the "interpersonal" factor.

It has been suggested that psychopathy may be comorbid with several other conditions than these, but limited work on comorbidity has been carried out. This may be partly due to difficulties in using inpatient groups from certain institutions to assess comorbidity, owing to the likelihood of some bias in sample selection.

Sex differences

Research on psychopathy has largely been done on men and the PCL-R was developed using mainly male criminal samples, raising the question of how well the results apply to women. Men score higher than women on both the PCL-R and the PPI and on both of their main scales. The differences tend to be somewhat larger on the interpersonal-affective scale than on the antisocial scale. Most but not all studies have found broadly similar factor structure for men and women.

Many associations with other personality traits are similar, although in one study the antisocial factor was more strongly related to impulsivity in men and more strongly related to openness to experience in women. It has been suggested that psychopathy in men manifests more as an antisocial pattern while in women it manifests more as a histrionic pattern. Studies on this have shown mixed results. PCL-R scores may be somewhat less predictive of violence and recidivism in women. On the other hand, psychopathy may have a stronger relationship with suicide and possibly internalizing symptoms in women. A suggestion is that psychopathy manifests more as externalizing behaviors in men and more as internalizing behaviors in women. Furthermore, one study has suggested substantial gender differences were found in the etiology of psychopathy. For girls, 75% of the variance in severe callous and unemotional traits was attributable to environmental factors and just 0% of the variance was attributable to genetic factors. In boys, the link was reversed.

Studies have also found that women in prison score significantly lower on psychopathy than men, with one study reporting only 11 percent of violent females in prison met the psychopathy criteria in comparison to 31 percent of violent males. Other studies have also indicated that high psychopathic females are rare in forensic settings.

Management

Clinical

Psychopathy has often been considered untreatable. Its unique characteristics make it among the most refractory of personality disorders, a class of mental illnesses that are already traditionally considered difficult to treat. People with psychopathy are generally unmotivated to seek treatment for their condition, and can be uncooperative in therapy. Attempts to treat psychopathy with the current tools available to psychiatry have been disappointing. Harris and Rice's Handbook of Psychopathy says that there is currently little evidence for a cure or effective treatment for psychopathy; as yet, no pharmacological therapies are known to or have been trialed for alleviating the emotional, interpersonal and moral deficits of psychopathy, and patients with psychopathy who undergo psychotherapy might gain the skills to become more adept at the 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 the behavior of psychopathic individuals as they are insensitive to punishment or threat. These failures have led to a widely pessimistic view on its treatment prospects, a view that is exacerbated by the little research being done into psychopathy compared to the efforts committed to other mental illnesses, which makes it more difficult to gain the understanding of this condition that is necessary to develop effective therapies.

Although the core character deficits of highly psychopathic individuals are likely to be highly incorrigible to the currently available treatment methods, the antisocial and criminal behavior associated with it may be more amenable to management, the management of which being the main aim of therapy programs in correctional settings. It has been suggested that the treatments that may be most likely to be effective at reducing overt antisocial and criminal behavior are those that focus on self-interest, emphasizing the tangible, material value of prosocial behavior, with interventions that develop skills to obtain what the patient wants out of life in prosocial rather than antisocial ways. To this end, various therapies have been tried with the aim of reducing the criminal activity of incarcerated offenders with psychopathy, with mixed success. As psychopathic individuals are insensitive to sanction, reward-based management, in which small privileges are granted in exchange for good behavior, has been suggested and used to manage their behavior in institutional settings.

Psychiatric medications may also alleviate co-occurring conditions sometimes associated with psychopathy or with symptoms such as aggression or impulsivity, including antipsychotic, antidepressant or mood-stabilizing medications, although none have yet been approved by the FDA for this purpose. For example, a study found that the antipsychotic clozapine may be effective in reducing various behavioral dysfunctions in a sample of high-security hospital inpatients with antisocial personality disorder and psychopathic traits. However, research into the pharmacological treatment of psychopathy and the related condition antisocial personality disorder is minimal, with much of the knowledge in this area being extrapolations based on what is known about pharmacology in other mental disorders.

Legal

The PCL-R, the PCL:SV, and the PCL:YV are highly regarded and widely used in criminal justice settings, particularly in North America. They may be used for risk assessment and for assessing treatment potential and be used as part of the decisions regarding bail, sentence, which prison to use, parole, and whether a youth should be tried as a juvenile or as an adult. There have been several criticisms against its use in legal settings. They include the general criticisms against the PCL-R, the availability of other risk assessment tools that may have advantages, and the excessive pessimism surrounding the prognosis and treatment possibilities of those who are diagnosed with psychopathy.

The interrater reliability of the PCL-R can be high when used carefully in research but tends to be poor in applied settings. In particular Factor 1 items are somewhat subjective. In sexually violent predator cases the PCL-R scores given by prosecution experts were consistently higher than those given by defense experts in one study. The scoring may also be influenced by other differences between raters. In one study it was estimated that of the PCL-R variance, about 45% was due to true offender differences, 20% was due to which side the rater testified for, and 30% was due to other rater differences.

To aid a criminal investigation, certain interrogation approaches may be used to exploit and leverage the personality traits of suspects thought to have psychopathy and make them more likely to divulge information.

United Kingdom

The PCL-R score cut-off for a label of psychopathy is 25 out of 40 in the United Kingdom, instead of 30 as it is in the United States.

In the United Kingdom, "psychopathic disorder" was legally defined in the Mental Health Act (UK), under MHA1983, 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". This term was intended to reflect the presence of a personality disorder in terms of conditions for detention under the Mental Health Act 1983. Amendments to MHA1983 within the Mental Health Act 2007 abolished the term "psychopathic disorder", with all conditions for detention (e.g. mental illness, personality disorder, etc.) encompassed by the generic term of "mental disorder".

In England and Wales, the diagnosis of dissocial personality disorder is grounds for detention in secure psychiatric hospitals under the Mental Health Act if they have committed serious crimes, but since such individuals are disruptive to other patients and not responsive to usual treatment methods this alternative to traditional incarceration is often not used.

United States

"Sexual psychopath" laws

Starting in the 1930s, before some modern concepts of psychopathy were developed, "sexual psychopath" laws, the term referring broadly to mental illness, were introduced by some states, and by the mid-1960s more than half of the states had such laws. Sexual offenses were considered to be caused by underlying mental illnesses, and it was thought that sex offenders should be treated, in agreement with the general rehabilitative trends at this time. Courts committed sex offenders to a mental health facility for community protection and treatment.

Starting in 1970, many of these laws were modified or abolished in favor of more traditional responses such as imprisonment due to criticism of the "sexual psychopath" concept as lacking scientific evidence, the treatment being ineffective, and predictions of future offending being dubious. There were also a series of cases where persons treated and released committed new sexual offenses. Starting in the 1990s, several states have passed sexually dangerous person laws, including registration, housing restrictions, public notification, mandatory reporting by health care professionals, and civil commitment, which permits indefinite confinement after a sentence has been completed. Psychopathy measurements may be used in the confinement decision process.

Prognosis

The prognosis for psychopathy in forensic and clinical settings is quite poor, with some studies reporting that treatment may worsen the antisocial aspects of psychopathy as measured by recidivism rates, though it is noted that one of the frequently cited studies finding increased criminal recidivism after treatment, a 2011 retrospective study of a treatment program in the 1960s, had several serious methodological problems and likely would not be approved of today. However, some relatively rigorous quasi-experimental studies using more modern treatment methods have found improvements regarding reducing future violent and other criminal behavior, regardless of PCL-R scores, although none were randomized controlled trials. Various other studies have found improvements in risk factors for crime such as substance abuse. No study has yet examined whether the personality traits that form the core character disturbances of psychopathy could be changed by such treatments.

Frequency

A 2008 study using the PCL:SV found that 1.2% of a US sample scored 13 or more out of 24, indicating "potential psychopathy". The scores correlated significantly with violence, alcohol use, and lower intelligence. A 2009 British study by Coid et al., also using the PCL:SV, reported a community prevalence of 0.6% scoring 13 or more. However, if the scoring was adjusted to the recommended 18 or more, this would have left the prevalence closer to 0.1%. The scores correlated with younger age, male gender, suicide attempts, violence, imprisonment, homelessness, drug dependence, personality disorders (histrionic, borderline and antisocial), and panic and obsessive–compulsive disorders.

Psychopathy has a much higher prevalence in the convicted and incarcerated population, where it is thought that an estimated 15–25% of prisoners qualify for the diagnosis. A study on a sample of inmates in the UK found that 7.7% of the inmates interviewed met the PCL-R cut-off of 30 for a diagnosis of psychopathy. A study on a sample of inmates in Iran using the PCL:SV found a prevalence of 23% scoring 18 or more. A study by Nathan Brooks from Bond University found that around one in five corporate bosses display clinically significant psychopathic traits - a proportion similar to that among prisoners.

Society and culture

In the workplace

Main article: Psychopathy in the workplace

There is limited research on psychopathy in the general work populace, in part because the PCL-R includes antisocial behavior as a significant core factor (obtaining a PCL-R score above the threshold is unlikely without having significant scores on the antisocial-lifestyle factor) and does not include positive adjustment characteristics, and most researchers have studied psychopathy in incarcerated criminals, a relatively accessible population of research subjects.

However, psychologists Fritzon and Board, in their study comparing the incidence of personality disorders in business executives against criminals detained in a mental hospital, found that the profiles of some senior business managers contained significant elements of personality disorders, including those referred to as the "emotional components", or interpersonal-affective traits, of psychopathy. Factors such as boldness, disinhibition, and meanness as defined in the triarchic model, in combination with other advantages such as a favorable upbringing and high intelligence, are thought to correlate with stress immunity and stability, and may contribute to this particular expression. Such individuals are sometimes referred to as "successful psychopaths" or "corporate psychopaths" and they may not always have extensive histories of traditional criminal or antisocial behavior characteristic of the traditional conceptualization of psychopathy. Robert Hare claims that the prevalence of psychopathic traits is higher in the business world than in the general population, reporting that while about 1% of the general population meet the clinical criteria for psychopathy, figures of around 3–4% have been cited for more senior positions in business. Hare considers newspaper tycoon Robert Maxwell to have been a strong candidate as a "corporate psychopath".

Academics on this subject believe that although psychopathy is manifested in only a small percentage of workplace staff, it is more common at higher levels of corporate organizations, and its negative effects (for example, increased bullying, conflict, stress, staff turnover, absenteeism, reduction in productivity) often causes a ripple effect throughout an organization, setting the tone for an entire corporate culture. Employees with the disorder are self-serving opportunists, and may disadvantage their own organizations to further their own interests. They may be charming to staff above their level in the workplace hierarchy, aiding their ascent through the organization, but abusive to staff below their level, and can do enormous damage when they are positioned in senior management roles. Psychopathy as measured by the PCL-R is associated with lower performance appraisals among corporate professionals. The psychologist Oliver James identifies psychopathy as one of the dark triadic traits in the workplace, the others being narcissism and Machiavellianism, which, like psychopathy, can have negative consequences.

According to a study from the University of Notre Dame published in the Journal of Business Ethics, psychopaths have a natural advantage in workplaces overrun by abusive supervision, and are more likely to thrive under abusive bosses, being more resistant to stress, including interpersonal abuse, and having less of a need for positive relationships than others.

In fiction

Main article: Fictional portrayals of psychopaths

Characters with psychopathy or sociopathy are some of the most notorious characters in film and literature, but their characterizations may only vaguely or partly relate to the concept of psychopathy as it is defined in psychiatry, criminology, and research. The character may be identified as having psychopathy within the fictional work itself, by its creators, or from the opinions of audiences and critics, and may be based on undefined popular stereotypes of psychopathy. Characters with psychopathic traits have appeared in Greek and Roman mythology, Bible stories, and some of Shakespeare's works.

Such characters are often portrayed in an exaggerated fashion and typically in the role of a villain or antihero, where the general characteristics and stereotypes associated with psychopathy are useful to facilitate conflict and danger. Because the definitions, criteria, and popular conceptions throughout its history have varied over the years and continue to change even now, many of the characters characterized as psychopathic in notable works at the time of publication may no longer fit the current definition and conception of psychopathy. There are several archetypal images of psychopathy in both lay and professional accounts which only partly overlap and can involve contradictory traits: the charming con artist, the deranged serial killer and mass murderer, the callous and scheming businessperson, and the chronic low-level offender and juvenile delinquent. The public concept reflects some combination of fear of a mythical bogeyman, the disgust and intrigue surrounding evil, and fascination and sometimes perhaps envy of people who might appear to go through life without attachments and unencumbered by guilt, anguish or insecurity.

See also

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