Psychopathy: The Introduction


Sad, Mad or Bad?

We hear of them in the media, see them in fictional portrayals and dish the label to the most depraved individuals, but who and what are Psychopaths? What do they do and why do they do it? Formally known as ‘Moral Insanity’ until the 20th century; Psychopathy is a serious personality disorder characterized by a lack of empathy, conscience and remorse. In 1941, Hervey Cleckley’s landmark book The Mask of Sanity pioneered the apprehension of this disorder. Representing less than 1% of the population, psychopathic individuals can appear significantly superficial and charming, yet these Wolves in Sheep’s clothing conceal a deceitful and domineering persona.

Canadian psychologist Robert D. Hare shed new light on the construct of psychopathy in Criminology with his Psychopathy Checklist (PCL-R). Some countries widely conduct self report assessments and interviews in criminal justice settings, which may have notable consequences for those involved. ‘NeuroLaw’ is a new phenomenon where neuroscience can be used as evidence in the courtroom. Currently, there is no ‘Psychopathy’ titled diagnosis in Psychiatry, although in some cases Antisocial Personality Disorder (Sociopathy) from the DSM and Dissocial Personality Disorder in the ICD may be applied. Researchers such as Robert Hare and Stephen Hart regard the mainstream psychiatric view as deeply flawed, calling for a return to a traditional model of Psychopathy as a distinct disorder.

Psychopathic Characteristics

Essentially, Psychopathy is characterized by tenacious behavioral deviancy accompanied by emotional-interpersonal detachment. The triarchic model, formulated by Christopher J. Patrick contrasts historic and contemporary conceptualizations of the disorder. It suggests that different conceptions of psychopathy emphasize three distinguishable phenotypic facets to varying degrees:

  • Boldness: Nexus of emotional resilience, low fear, toleration of unfamiliarity and danger (venturesomeness) and social dominance. Fearless dominance may correspond to differences in the amygdala and other neurological systems associated with fear.
  • Disinhibition: Poor impulse control which includes problems with planning and foresight, lacking affect and urge control, and requirement of instant gratification. 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, exploitative tendencies, use of cruelty to gain empowerment, defiance of authority and destructive excitement seeking.

“I have an obsession with the unattainable. I have to eliminate what I cannot attain.” – Robert Bardo

Primary and Secondary Psychopathy

Several researchers have argued that there exist two variants of Psychopaths; Primary and Secondary (Cold/Hot). I personally believe is the case, thus I shall base the majority of my posts on Psychopathy around this conceptualization. 

Primary Psychopaths: Characterized as having an intrinsic deficit that hampers self regulation and normal adjustment. This results in fearlessness, poor passive avoidance, weak electrodermal anticipation of punishment and average levels of positive and negative emotionality.

Secondary Psychopaths: Believed to have more fear, anxiety and negative emotions than Primary Psychopaths. This manifests as relatively high levels of positive and negative emotionality, increased sensitivity to rewards, impulsiveness and sensation seeking but average levels of fearlessness, passive avoidance and electrodermal anticipation of punishment. There is empirical evidence to suggest Secondary Psychopaths manifest more Borderline Personality Disorder traits and comparable levels of antisocial behavior.

There are also different theories as to the predominant causes of either variant and apparently measures of anxiety can help to discern the etiology of the condition. Some researchers, such as Benjamin Karpman, believe that Primary Psychopaths are born with an emotional deficit and that Secondary Psychopaths acquire it through adverse environmental experiences, although others, link both variants to biological predispositions. Some preliminary research suggests that Secondary Psychopaths may have had a more abusive childhood, a higher risk of future violence, and potentially a better response to treatment.


The Psychopaths Childhood

“I hated all my life. I hated everybody. When I first grew up and can remember, I was dressed as a girl by mother. And I stayed that way for two or three years. And after that was treated like what I call the dog of the family. I was beaten. I was made to do things that no human bein’ would want to do.” – Henry Lee Lucas

Many Psychopaths (not all), suffered horrendous emotional, physical and sexual abuse/neglect at the hands of parents or caregivers, which can have adverse effects on neurological development as mentioned in The Effects of Toxic Stress in Childhood post. Though, it is possible to see risk indicators of psychopathy very early through behaviors such as bullying, killing of animals, pyromania, kleptomania, bed-wetting etc. 

Conduct disorder is diagnosed based on a prolonged pattern of antisocial behavior in childhood and/or adolescence, and is often a precursor to Antisocial Personality Disorder. It is speculated that there are two subtypes of conduct disorder which mark dual developmental pathways to adult psychopathy. Juvenile psychopathy appears to be associated with higher levels of negative emotionality (i.e anger, hostility, anxiety, and depression). Early-onset conduct disorder and ADHD are linked with life-course-persistent antisocial behaviors as well as psychopathy. Generally, girls display significantly higher rates of physical and relational aggression than boys. They are highly aggressive toward both girls and boys, whereas boys are highly aggressive only toward other boys.

Evidence indicates the children with a combination of ADHD and Conduct Disorder are more belligerent and antisocial than those with only conduct disorder (although the majority of young children have both). Their behavioral disinhibition resembles that of adult Psychopaths and some believe this combination may give rise to Adult Secondary Psychopathy.

“As I grew up I realized, though imperfectly, that I was different from other people, and that the way of life in my home was different from that in the homes of others….This stimulated me to introspection and strange mental questionings” – John Haugh

The Psychopaths Brain

Post mortems studies have frequently shown undeveloped regions of the brain responsible for governing emotions. Professor of Psychiatry, James Fallon studied brain scans for over 20 years and noticed how cold, hardened murderers had alarmingly low activity in the frontal and temporal lobes of the brain, the areas associated with empathy and self-control. Without that self-restraint, they became crazed killers. Dysfunctions in the prefrontal cortex and amygdala regions of the brain are associated with specific learning impairments. Magnetic resonance scan MRI of the head computer enhanced and colorized to show the normal anatomy of the brain and head

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 were similar to Psychopaths as their brains were incapable of acquiring social and moral knowledge. Thus, 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.

Amygdala and ventromedial prefrontal cortex abnormalities 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 fasciculus—white matter connecting the amygdala and orbitofrontal cortex. In time, I shall post more on these findings.

Psychopathy in the UK

The PCL-R cut-off for Psychopathy label is 25 in the UK, whereas it is 30 in the US. ‘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.

With the subsequent amendments to the Mental Health Act 1983 within the Mental Health Act 2007, the diagnosis was abolished, with all conditions for detention (e.g. mental illness, personality disorder, etc.) now being contained within the generic term of ‘mental disorder’. Today, 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 for other patients and not responsive to treatment imprisonment is often avoided.

“Possessing them physically as one would possess a potted plant, a painting, or a Porsche. Owning, as it were, this individual.” – Theodore Bundy


As notoriously amoral individuals. it’s no surprise that psychopathy scores are positively correlated with repeated imprisonment, detention in higher security, disciplinary infractions, and substance misuse. Generally, Psychopathy is associated with several adverse life outcomes as well as increased risk of early death due to factors such as homicides, accidents, and suicides. Hare stated that
although psychopaths only make up about 1% of the general population, they account for a large proportion of the violence and social distress in every society. They make up 15%–20% the US prison inmates and are common among spouse and child abusers, gang members and terrorists. An important note is that Sociopathy and Psychopathy are NOT the same. Sociopathy tends to be an inclusive part of the Psychopaths make up as criminality and disregard for authority are significantly relevant. Studies have shown Sociopaths make up almost 70-80% of some jails, but many Sociopaths are not Psychopaths, which is a common misconception today.

Violence: Studies show a strong correlation between psychopathy scores and violence, especially concerning victims of abuse who then go on to commit violent acts. For some, aggression and violence have become a habitual way to deal with frustration and stress which echos in their social interactions. Furthermore, the Federal Bureau of Investigation 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. 

Sexual Offences:  Sexual fantasies and paraphilia are associated with psychopathic sexual abuse more than non-Psychopaths. Child molesters, masturbation, fetichism, exhibitionism, sadism, masochism, bestiality and necrophilia also bare strong links to psychopathy. Regarding, 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 than they should be excluded from any consideration of being placed in a home with children under any circumstances.

Economic Crime: The words of Dr Robert Hare echo ‘If I wasn’t studying Psychopaths in prison, I’d do it at the stock exchange’. These ‘Snakes in Suits’ may be socially successful, due to factors such as low disinhibition alongside other advantages such as a favorable upbringing and good intelligence. Financial expert Max Keiser uses the term ‘financial terrorist’ to describe the low-empathy, cold left-brain thinking which currently dominates elite financial circles, particularly in the City of London and Wall Street.

Other offences: Psychopathy has been associated with organised and war crimes. Terrorists are sometimes called psychopaths they tend to exhibit traits such as violence, an egocentric world view that prohibits the welfare of others, a lack of remorse or guilt, and blame externalization. Though, John Horgan, author of The Psychology of Terrorism, argues that this assumption could also be drawn more widely: for example, to soldiers in wars. Plus, terrorist activity requires organization, loyalty and ideology; traits such as self-centeredness, irresponsibility, poor behavioral controls, and unusual behaviors may be disadvantages.


Gender differences

This area warrants more expansion of research and knowledge. The PCL-R was developed using mainly male criminal samples reflecting the fact that most research has been based on men. They score higher than women on both the PCL-R and the Psychopathic Personality Inventory (PPI). One study found, men with psychopathic personality traits had experienced more victimization regarding physical abuse and women with psychopathic personality traits had experienced more victimization of sexual abuse but also neglect and verbal abuse. Furthermore men tend to exhibit more external antisocial behaviors and woman more internalizing behaviors. Though, this is not always the case.

Psychopaths in Films

The arrestshanniballecter and infamy of serial killers John Wayne Gacy, Jeffrey Dahmer, and Ted Bundy altered the perceptions and depictions of psychopathy in film. An increasing interest in realistic depictions of psychopaths led to the formation of a new hybrid of traditional psychopaths from early film and late-19th Century literature with the high-functioning behaviors detected in psychopaths such as Bundy (was his own defence attorney) and Dahmer.

Cannibalistic Psychiatrist Dr. Hannibal Lecter from the 1991 film The Silence of the Lambs. Lecter is erudite with disarming charisma and wit that conceal his true psychopathic nature. The Joker kills not to gain riches, as the other criminals in Batman, but actually for the sheer fun of it. This representation is credible, though in reality most Psychopaths are much harder to detect. They usually don’t look as abhorrent or behave openly psychotic as the Joker does.

Causes of Psychopathy

Genetic: Studies have indicated a connection between a variant of the monoamine oxidase A (MAO-A) gene (warrior gene) which controls the amount of serotonin in the brain and psychopathy. Whilst studying the brains of killers for over 20 years, Professor James Fallon discovered that he was carrying this gene, had a lineage of very violent killers including Lizzie Borden, and his brain was very similar to the mass murderers he studied. Apparently, his terrific childhood had saved him from going over the edge despite being a ‘born killer’.

Environment: Some of the strongest factors said to influence the development of psychopathy include , being physically neglected, low involvement of the father with his son, having a convicted parent, low socioeconomic background, and being raised in a dysfunctional family. Other significant factors include lack of supervision, harsh discipline, large family size, delinquent sibling, young mother, depressed mother, poor housing and severe peer bullying.

Biochemical: High levels of testosterone combined with low levels of cortisol and/or serotonin have been said to be contributing factors. More testosterone relative to cortisol acting on the amygdala, can cause an individual to become less fearful, more reward seeking and aggressive. It enhances sensitivity to reward relative to punishment, promotes approach rather than avoidance reactions, and reduces the emotional input from the amygdala to the orbitofrontal cortex that is critical for empathy and recognizing cues that a decision may be risky or harmful. It may also impair the ability to regulate emotion and aggression.

Hervey Cleckley believed the physiological basis for this dangerous personality disorder was because neither side of the Psychopath’s brain processes emotion properly. To psychopaths, emotionally charged statements such as ‘I love you,’ or ‘I’m sorry that I hurt you’, I’ll never do it again’ mean absolutely nothing and are simply words used to deceive and manipulate.

wolves in sheep's clothing

So that’s my introduction, it is quite long, though not long enough. My aim was to give a brief overview and dispel some of the mainstream myths of psychopathy as many people like to fling the label around. Plenty of victims and researchers are understandably skeptical to the idea that people with psychopathic personality traits are treatable; their behavior is profoundly pathological. Though, in regards to treatment previous abuse should be addressed, victimization should be validated and men may possibly need more focus on behavioral control and anger management due to their proneness to externalizing behaviors (i.e, violent outbursts and sexual perversion), whereas women might need more help with their internal emotions and behaviors (e.g, self harming behaviors, feelings of anger) and therefore require longer therapy and motivational interviewing. There is possibility for remission and positive outcomes if treatment is tailored to the individuals problems.


Economics and Finance student. University of Southampton. Autodidact. INTJ. Psychiatry devotee. To myself I am only a child playing on the beach, while vast oceans of truth lie undiscovered before me - Isaac Newton. Any Questions? Email:

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Posted in Behavioural Neuroscience, Psychiatry, Psychology, Psychopathy

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