It was the American psychiatrist Hervey M Cleckley who formalised the concept of the psychopath in his book The Mask of Sanity, which was based on interviews with inmates in high security prisons.
Psychopathy is diagnosed using an assessment tool that scores individuals against a series of criteria. Those above a certain threshold are officially classified as psychopaths — although psychopathy is a spectrum and most psychopaths are not violent criminals in fact, some are very successful in the business world. However, those that are tend to be criminally versatile.
Among imprisoned violent offenders, a minority are psychopathic. Among imprisoned violent offenders, only a minority are psychopathic Credit: Getty Images. But once a psychopath is in prison, it is important to figure out how to better rehabilitate them: they are up to four times more likely to reoffend than non-psychopaths. Although people with ASPD may come across as happy-go-lucky and likeable, in the face of conflict they can quickly snap and become frightening. In a minority of cases, violent offenders will meet the diagnostic criteria for both ASPD and psychopathy. Blackwood and his colleagues have identified differences in the brains of such offenders, which set them apart from offenders with only ASPD and from healthy non-offenders.
Many violent offenders meet the criteria for both antisocial personality disorder and psychopathy Credit: Getty Images. Psychopaths seem to process information about punishment and reward differently to ordinary people. Most children go through a phase of hitting or biting other children, but most eventually learn that this is inappropriate behaviour that will be punished.
Psychopaths, though, seem relatively unfazed by punishment, which makes them very difficult to manage. Group therapy can help individuals better understand why they behave the way they do Credit: Alamy. More advanced research regards interventions targeting violent offenders with ASPD. Not only could this cause them to misinterpret actions as more threatening than they are; it could also make it harder for them to regulate these emotions, because they struggle to understand their own feelings.
Peter Fonagy, a psychoanalyst and clinical psychologist at University College London, is currently overseeing a trial of mentalisation-based group therapy with violent offenders who have been released on probation — most of whom have ASPD. Each week, they meet and discuss issues that are currently important to them, with the goal of introducing a more nuanced understanding of their own position and those around them. Mentally unpacking the event often causes the heat of an emotional situation to dissipate, reducing the urge to do something impulsively.
Already, Fonagy and colleagues have successfully used mentalisation to help people with another disorder, borderline personality disorder BPD , which is characterised by emotional instability and frequent self-harm. One study saw improvements in mood and interpersonal functioning which could still be detected eight years later.
Negative emotions are background noise. I laugh with people, I enjoy intellectual discussions. Do you feel at all that your psychopathy is an advantage to you? Do you feel lucky in any sense? With psychopathy I constantly have to figure out people, and why they do what they do, and how to respond to them. Normal people have to deal with grief and loss and pain and heartbreak, but they also have things to make them happy. I could easily take psychopathy and make it a terribly negative thing for both me and the world, because I could make bad choices, and do terrible things. Anyone can make bad choices for themselves.
Do you still see the doctor who diagnosed you, or do you sort of have any regular treatment that you do? I learn about it by reading studies. We never spoke again. And actually we respond very differently to medications as well, because our chemistry is different, so you can expect strange medication reactions. Whenever a doctor prescribes the medication, I can pretty well expect it to not work as intended. Does that apply to something as innocuous as a cold medication?
I have no comprehension of why people enjoy opioids. There are psychopaths that use drugs, but you can cut them off cold turkey and they will not have any withdrawal. So we just lack certain normal cues that other people have. Or your family?
Do you have a relationship with your parents? They know me for what they need to know me for.
Trying to explain psychopathy to people, especially older people, is really difficult. And the word has so much negative stigma. They have absolutely no interest in hearing past evil, dangerous, killer, malicious, out to get you. The things people assume about psychopathy are crazy. And you may never get it back.
When you meet new people, whether professionally or personally or whatever context, do you present them with the version of yourself that fits the situation? They just need to know what they can expect of me.
And even with the people who do know me, and do know how I actually am, there still has to be a mask. I have a friend who will feel like I resent her spending time with me. I have to make that connection. Does that friend know what your diagnosis is? Yes, she knows, and she tries very hard. She makes adjustments for me, I make adjustments for her.
Developmentally, symptoms of psychopathy have been identified in young children with conduct disorder , and is suggestive of at least a partial constitutional factor that influences its development. The egg that would help form her ended up with two copies of chromosome Mosby, St. Jen separated them, and once they were home, she pulled Samantha aside. However, there is still little research on the successful psychopath living in the community, compared to the failed psychopath, which make up the vast majority of subjects in the study of psychopathy Raine
What can I do for you? You have to engage. I learned very early on that there are responses that are required for people to not be very uncomfortable. Why do you think some people respond that way to you? Do you have any idea? I think it comes from a visceral fear of the unknown, or fear of evil. Hollywood has desperately pushed this narrative of psychopathy.
Is there anything that you feel that I left out, that you would like to add?
Psychopathy - characterised by "a persistent disregard for social norms and conventions; impulsivity, unreliability, and irresponsibility; lack of empathy, remorse and emotional depth; and failure to maintain enduring attachments to people, principles, or goals" Hare, , p. However, Cleckley , original work published in described two interesting case studies of female psychopaths, Roberta and Anna, in The Mask of Insanity. Hemphill, Hare and Wong's review of the literature on the PCL-R concluded that "the PCL-R should be considered a primary instrument for guiding clinical appraisals of criminal recidivism and dangerousness" p.
This fact often leads to a debate on lowering the cut-off scores for female offenders. The latter authors suggest examining the influence of moderator variables, such as gender and race, in order to strengthen the link between the PCL-R and recidivism. The authors used different psychopathy instruments PCL-R, the Anti-Social Scale of the Personality Assessment Inventory and of the Personality Disorder Examination with female offenders and concluded that psychopathy only moderately predicts recidivism in female offenders.
In addition, the classification accuracy for psychopathy as a predictor of recidivism was modest to poor i. However, the behavioural criteria of the different instruments did not predict recidivism. In short, a classification of psychopathy characterised by behavioural symptoms added little to the prediction of recidivism in this small sample of female offenders. The authors comment that caution is needed when using psychopathy measures with females. This is underscored by Jackson, Rogers, Neumann and Lambert The limitations of Salekin's study have been highlighted by Cale and Lilienfeld , who conducted additional analyses which "do not support the claim that the factor structure of psychopathy differs markedly in males and females" p.
Richards, Casey and Lucente provide strong evidence for the hypothesis that particularly Factor 1 is related to increased risk for recidivism in incarcerated female substance abusers after treatment and release in the community. Loucks and Zamble found that in contrast to common findings for male offenders, "Factor-1 scores are as closely related to criminal behavior [in serious female offenders] as Factor-2 scores" p.
Vitale, Smith, Brinkley and Newman examined adult, nonpsychotic incarcerated women, one half Caucasian and one half African American.