Psychopath or Psychotic?
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Psychosis and psychopathy are two conditions that are sometimes confused. It is understandable, given that the name of the two disorders sound quite similar (both begin with the prefix “psycho”).
Another possible reason for the confusion is that some individuals with psychopathy commit heinous crimes (e.g., rape of a small child | jealous rageful killing of a boyfriend) that leads one to conclude –
“Only a delusional person could commit such a horrendous callous act!“
One could erroneously assume that the mind of such a person has to be disordered in a delusional or psychotic manner. The perpetrator must have experienced some kind of break from reality and be “out of their mind.”
But for psychopaths this is not the case.
Sometimes those involved in legal cases of a psychopath (with minimal knowledge of the symptom profile of the condition) might view their odd, detached, limited emotional presentation as one who
a) must be burying their true emotions,
b) trying hard not to face the pain, or
c) attempting to cope with the damage they caused their victim.
Such conclusions regarding a psychopath would be extremely off-base and inaccurate.
In order to have those reactions (a – c) the person would have to be capable of empathy, guilt, and care based morality – three emotional processing abilities individuals with strong psychopathic traits do not experience. They do not have a conscience.
Perpetrators with psychopathy have no inner turmoil following the victimization of another, regardless of the magnitude.
“Why are we still even talking about this!” is their state of mind.
In its most extreme forms, a criminal psychopath can commit a murder at 3:00 and meet up with a date at 6:00, enjoy a sexual encounter and a cocktail.
No shame, no guilt, no anxiety, no distress. Life moves on as usual.
However, this is consistent with individuals who are callous, cold, uncaring, aggressive, arrogant, and incapable of guilt and shame.
When trying to make sense of a psychopath’s behavior, non-psychopathic individuals tend to have a desire to overlay a normal person’s response to the psychopath’s odd, disinterested/ remorseless display.
“He must feel burdened by what he has done!”
“He will have to suffer with the pain he caused for the rest of his life!”
Those statements will not be true for the violator with strong psychopathic traits. Sadly, lacking a fully functional system of morality frees them from the burden of guilt, accountability, or any focus or concern for the victim’s pain.
They simply do not care.
Due to their brain disorder – they cannot care.
It can be difficult to fully comprehend the emotional limitations of someone with psychopathy. However, to interpret their behavior through the lens of what a normal person might do would lead one down the wrong road.
They are not suppressing feelings or struggling with guilt or plagued with remorse that they are not expressing. They simply do not care. When one lacks care based morality, there is no feelings for the harm caused to another. Others are to be used as ‘things’ – even when the use is perverse and extremely destructive to the target.
• The fact is, individuals with strong psychopathic traits have an emotional deficiency that strongly impairs the ability to feel: Remorse, caring, empathy, accountability, and emotional control (particularly of anger/ rage).
They have emotional processing problems, typically in the presence of normal to above intelligence (Kiehl & Buckholtz, 2010).
• One who focuses on self only and is pathologically geared to always put themselves first, with a preoccupation with domination and control can commit heinous, almost unthinkable acts that repulse the rest of us.
• The error would be in assuming that only a person who is “crazy” or “psychotic” would commit such an act.
Individuals with psychopathy do not experience a break from reality. They are not psychotic (i.e., delusional, confused, hallucinating).
Their ‘insanity‘ is within their morals.
They cannot bond and their emotional processing is dysfunctional. Many are hateful, hypersensitive, punitive, controlling, arrogant, and manipulative. They are often positively stimulated by their domination of others and enjoy the pain they cause.
So, now let’s take a look at a comparison of psychosis and psychopathy so that there will be no confusion regarding the terms.
Psychosis and Psychopathy
Psychosis and psychopathy are vastly different and have minimal resemblance clinically. Of the two groups, psychopaths are actually more dangerous and a threat to society than those with psychosis.
Psychotic individuals are typically unable to conceal or hide their symptoms from others. Their sickness is reflected in their thoughts, behavior, and affect/mood – sometimes even in their physical appearance (disheveled /unkempt).
Schizophrenia and bipolar disorder are examples of psychotic disorders.
Most likely if one is in the presence of someone who suffers with a psychotic disorder, they will know (e.g., the individual might be talking to themselves; hearing voices, discussing unusual beliefs – “The people on t.v. are trying to poison me!”)
Psychotic individuals are extremely out of touch with reality. They could be actively experiencing delusions, hallucinations, and severe confusion.
Their thoughts tend to be disorganized and often their speech patterns are unusual. They can experience significant fear, anxiety, sadness, despair, depression, and guilt. Many may turn to substances to ease their symptoms. They tend to have difficulty relating to others, an odd affect, and an inability to conceal their symptoms.
They need immediate help and often the hallucinations and delusions are not a pleasant experience for them. Their delusions and hallucinations often have a negative or frightening theme (e.g., negative commands, persecution, paranoia).
The prevalence of this disorder is approximately 2% of the general population. There is no cure, however the treatments are helpful with many of the symptoms – particularly the delusions and hallucinations. There are medications and specific therapy interventions for the various psychoses.
An individual within a psychotic state has minimal capacity to function without medication to manage their symptoms. They may even require immediate psychiatric hospitalization. When in a psychotic state they are unable to hold a job and often they cannot provide even the most basic care for themselves (e.g., hygiene, food, shelter).
They certainly cannot lead others, run a business, or manipulate. They do not blend in well with the crowd, as others in society tend to be able to detect they are ill.
Many psychotic individuals are distressed and living within an altered reality created within their mind. These individuals can commit violent crimes while in their psychotic state. However, most are never violent, abusive, or dangerous to others in any manner.
Psychotic individuals are more likely to be the victim of a crime and ostracizing, rather than the aggressor.
Psychopaths, on the other hand have no delusions, hallucinations, or confusion. Their sickness is reflected in a lack of morality, an inability to relate and bond to other human beings, antagonism, absence of empathy, and emotional poverty.
They tend to be dominant, arrogant and controlling. They use people for personal gain. Psychopaths have full cognitive capacity for calculated, well thought out and organized plans. Many psychopaths hunt, groom, and manipulate people – psychotics do not.
Psychopaths are ground in reality, although their perception of self is severely grandiose and overinflated. Psychopaths can appear completely normal and in fact some of them hold extremely prestigious positions in business and politics. They could be your boss, a politician, neighbor, clergyman, car salesman, office manager, or date.
There are no medications or specific therapeutic interventions (to date) that have been successful with this population.
Unlike psychotic individuals, most psychopaths cannot be easily spotted.
Psychopathic individuals are more likely to be the aggressor of a crime, rather than the victim, in comparison to those with psychosis.
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Blair, RJ. (2007). The amygdala and ventromedial prefrontal cortex in morality and psychopathy. Trends Cogn Sci. Sep;11(9):387-92.
Kiehl, K. & Buckholtz, J. (2010). Inside the mind of a psychopath. Scientific American Mind September/ October, 21, 22 – 29