Exploring relationships with partners devoid of morals, empathy, honesty and a conscience

What is psychopathy?
What is Psychopathy?



May 6, 2013

What is a Psychopath?

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The truth is, the personality structure of the psychopath spells trouble for the rest of us.” ~ Robert Hare, PhD | Without Conscience, 1993, p. 87

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Psychopathy is a  neurodevelopmental (personality) disorder (Blair, 2010). This condition is unique from other disorders of the mind, as this particular group of individuals tend to disrupt or harm the safety and well-being of others. They pose a risk to society in general, and often negatively impact culture, politics, relationships, and work environments.

It it not uncommon for those with psychpathy to hurt and damage complete strangers – people who have no awareness they are on the psychopath’s radar. Some with psychopathy are predatory. They hunt or stalk other human beings for the sole purpose of violation, control, release of perverse fantasies, additions to their collection, sex, image, money, and/or power gratification. This can be via romantic relationships, work interactions, proximity (e.g., neighbor), or through the act of a crime (e.g., child molestation, rape, abduction, murder, business transactions, fraud, corporate misconduct, theft).

Although most with psychopathy are not criminals, a significant portion of criminals (particularly perpetrators of the most violent, heinous, and vile crimes) are psychopaths.

Psychopathic traits are not limited to one socioeconomic class or race. They can be found among all groups. They tend to be primarily male, however both men and women can have this personality disorder. The true estimate of women with psychopathy is suspected to be skewed, as some within this group might be misdiagnosed with borderline personality disorder. 

The devastation and pain caused from intimate involvement with a psychopath can be tremendous. There are some individuals who do not leave these relationships with their lives (e.g., Lacie Peterson); there are some who will not leave these relationships with intact mental health.

Why do they pose such a risk?

Psychopaths can be dangerous to others due to their dysfunctional bonding, preoccupation with domination and control, tendency toward aggression, and neurobiological make up. Some lack the insight to ‘see‘ themselves accurately and all lack the empathy to care.

“They deceive, manipulate and destroy the lives of others for their own gratification. They cheat people, barging into their lives, winning their trust, cleaning out their bank accounts and disappearing. They lie about their past and accomplishments to get what they want. They can be anybody.” (Davis-Barron, 1995, p 1315)

A few basics of psychopathy

• Psychopathy is a personality disorder. The symptoms are often associated with underlying neurobiological dysfunction, genetics, and/or environmental circumstances during childhood.  

• This disorder is associated with several regions and systems of the brain. For example, many studies support that individuals with strong psychopathic traits tend to have dysfunctional reward, morality, bonding, and affective/emotional processing systems. There are several additional variables at play with respect to psychopathy that impact the intensity and demonstration of some of the symptoms  (e.g., genetics, parenting, environment).

• Many of the symptoms of narcissistic personality disorder (NPD) are encompassed within the disorder of psychopathy.

• Research supports 2 possible variants of psychopathy – Primary and Secondary. There is some debate in the literature as to whether secondary psychopathy is ‘truly’ psychopathy (Skeem, Polaschek, Patrick, & Lilienfeld, 2011).

• With regard to primary psychopathy – the underlying cause is typically genetic. However, environmental factors can contribute to and/or exacerbate symptom expression as well.

• There is a paradox, as most with psychopathy can present themselves as one without psychopathology – ‘normal’ (i.e., mask – charming, exciting, fun, stable, calm, free of anxiety, initially likable). These positive symptoms are often confusing to others after they get a glimpse of the psychopath’s extremely maladaptive dark personality traits.

• Psychopaths lack empathy, however this is often in association with ’emotional empathy.’ Some with psychopathy can ‘read’ you, however cannot ‘feel’ you (Blair, 2005; Goleman, 2007). And on top of it all, they simply do not care.

• A few of the brain regions that are likely involved with psychopathy include, the amygdala, ventromedial prefrontal cortex (vmPFC), anterior insular cortex, anterior cingulate gyrus, and white matter communication tracts (e.g., right uncinate fasciculus), particularly between the vmPFC and the amygdala (Motzkin, Newman, Kiehl, & Koenigs, 2011; Kiehl, Bates, Laurens, Kristin, Hare & Liddle, 2006).

• To date, psychopathy is not an official ‘stand alone’ diagnosis for patient classification within the DSM-V. Therefore, if a psychiatrist or psychologist evaluates a patient and determines the behavioral, emotional, and social patterns are reflective of psychopathy, the diagnosis they must use is Antisocial Personality Disorder

• Research supports that individuals diagnosed with narcissistic personality disorder have some of the neurobiological impairments of psychopathy. This makes sense, given that narcissistic personality disorder is suspected to be along the spectrum of psychopathy. One study found (i.e., neuroimaging) those with narcissistic personality disorder to have problems associated with the right anterior insular cortex – a region of the brain suspected to be associated with empathy (Fan, Wonneberger, Enzi, de Greck, Ulrich, Tempelmann, Bogerts, Doering, & Northoff, 2010).

• Although psychopathy is often equated with criminal behavior, research supports that most psychopaths have never and will never commit a crime (Skeem, 2011; Skeem & Cooke, 2010).

• Within the disorder of psychopathy, there is variation. Although the core symptoms of those who have primary psychopathy tend to be similar   (i.e., callous, grandiose, pathological lying, glib, superficial; Hare, 2003), we do see differences amongst individuals with this disorder. There are some who have traits of other personality conditions present. There will be those who are extremely skilled socially and can speak well under any circumstances. There are those who cannot. There is a range; some with psychopathy are ‘more psychopathic’ than others – more dangerous. There is not a one size fits all when it comes to this character disorder.

Through new research studies we are learning more about the neurobiological foundation of this disorder. Therefore, the information currently available will likely be clarified, expanded, and possibly changed in the future. Science will push us forward, as new information becomes available.

There are several researchers who are leading the way in the investigation of this condition. These doctors are advancing science and helping victims, survivors, and society with their findings. Here are a few of my favorite researchers and experts:

Robert Hare, PhD

James Blair, PhD

Kent Kiehl, PhD

Michael Koenigs, PhD

Essi Viding, PhD

Christopher J. Patrick, PhD

Scott Lilienfeld, PhD

David Kosson, PhD 

Jennifer Skeem, PhD 

 

Rhonda Freeman, PhD | Clinical Neuropsychologist

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References  References

Blair, R.J, (2010). Psychopath, Frustration, and Reactive Aggression: The Role of Ventromedial Prefrontal Cortex, British Journal of Psychology, 101, 383 -399.

Blair, R. J. (2005). Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations. Conscious and Cognition, 14, 698-718.

Carré , J., Hyde, L., Neumann , C., Viding, E., & Hariri, A.  (2013). The Neural signatures of distinct psychopathic traits, Social Neuroscience, 8:2, 122-135

Davis-Barron S. (1995) Psychopathic patients pose dilemma for physicians and society. Canadian Medical Association Journal. 1995 Apr 15;152(8):1314-7.

Fan, Y., Wonneberger, C., Enzi, B., de Greck, M., Ulrich, Tempelmann,C., Bogerts, B., Doering, S., & Northoff,G. (2010). The narcissistic self and its psychological and neural correlates: An exploratory fMRI study. Psychological Medicine, Aug; 41 (8), 1641-1650.

Gao, Y., Glenn, A.L., Schug, R.A., Yang, Y., Raine, A. (2009). The Neurobiology of psychopathy: A neurodevelopmental Perspective. Canadian Journal of Psychiatry, 54(12), 813-823.

Goleman, D. (2007). Social Intelligence: The New Science of Human Relationships. Bantam Books.

Kiehl, K., Bates, A., Laurens, Kristin R.; Hare, R., & Liddle, P. (2006). Brain potentials implicate temporal lobe abnormalities in criminal psychopaths. Journal of Abnormal Psychology, Vol 115(3), Aug, 443-453

Motzkin JC, Newman JP, Kiehl KA, Koenigs M. (2011). Reduced prefrontal connectivity in psychopathy. Journal of Neuroscience, November 30; 31(48): 17348–17357.

Skeem, J. & Cooke, D. (2010). Is criminal behavior a central component of psychopathy? Conceptual directions for resolving the debate.  Psychological Assessment, 22, 433-445.

Skeem, J, Poythressb, N., Edensc, J., Lilienfeldd, S., & Caled., E. (2003). Psychopathic personality or personalities? Exploring potential variants of psychopathy and their implications for risk assessment. Aggression and Violent Behavior 8, 513 – 546

Skeem, J., Polaschek, D., Patrick, C., & Lilienfeld, S. (2011). Psychopathic personality: Bridging the gap between scientific evidence and public policy. Psychological Science in the Public Interest, 12, 95-162.

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