Psychopathy or sociopathy as it is called at times, is a type of personality disorder, clinically regarded as ‘Antisocial Personality Disorder’ (APD). Although a big percentage of incarcerated convicts may be described as suffering from APD, only about one-fourth of them could be diagnosed for psychopathy. Also only a small percentage of these psychopaths are violent offenders. Exhibition of superficial charm and persistent lying are the two common traits of psychopaths. The emotional deficit of psychopaths limits them to experience only a narrow range of emotions. Psychopaths are very skilled in projecting themselves in good light and can beat psychological tests. Adult psychopathy may be attributed to childhood behavioral problems. Modern research has shown that psychopathy is strongly associated with abnormalities in brain structure. Psychopathy checklist and revised checklist offer a reliable and consistent assessment of convicted criminals. However there has been a lack of success in efforts to treat typical psychopaths. Psychopathic individuals are generally viewed as incurable and could be benefitted when moved from treatment settings to facilitating environments.
The term ‘psychopathology’ was first used in 1896 and was directed at the behavior of certain individuals who committed crimes on impulse. Psychopathy or antisocial personality is a type of personality disorder which is clinically regarded as ‘Antisocial Personality Disorder’ (APD). The term ‘psychopathy’ is also used interchangeably with ‘sociopathy’ to describe individuals with APD. According to Dr. Robert Hare, an expert in psychopathy, the difference between psychopathy and sociopathy is based on how the describing person views the traits associated with APD. When anti-social behavior arises from any social conflicts, sociologists prefer the term ‘sociopath’. The term ‘psychopath’ is used by psychologists when the disorder arises from psychological, genetic or environmental factors. Studies undertaken by Hare have revealed that among the convicted criminals, 85% of them could be described as being affected by APD. However when they are diagnosed for psychopathy, only about 20% of them would qualify. Individuals with APD are also indifferent to threats of pain or punishments. With their careless attitude for these, there is very little that can deter them from indulging in criminal acts, when they seek them for some reason.
Identity and Characteristics
Psychopaths are charming and are focused on gaining from calculated efforts at the cost of others. A very small percentage of psychopaths are actually violent offenders with most of them being only sub criminals; deceiving, manipulating the unsuspecting. Exhibition of superficial charm and persistent lying are the two common traits of psychopaths. Psychopaths are very skilled in projecting themselves in good light and can beat psychological tests. Psychopaths were earlier assessed largely based on self reporting. The standard psychological tests used in assessing criminals were largely ineffective according to Hare. Assessments involving self-reporting were prone to manipulation by the subject. This apart, there were also wide disagreements among the observers too.
The emotional deficit of psychopaths limits them to experience only a narrow range of emotions. They are perfectly aware of what the society considers as right and wrong, but however don’t experience the feelings of love, remorse etc. that are part of the human qualities. With a seemingly lack of conscience, psychopaths go about freely in meeting their needs and dictating accordingly, with no feelings of guilt (Hare 1999).
Except for a satisfaction from the act committed, no other motive for their crime has been seen evident. The traits exhibited by psychopaths vary according to the psychiatrists presenting them. While some psychiatrists have included even as many as 55 traits as indicative of psychopaths, a more careful compilation of 16 traits can be attributed to Hervey M. Cleckley. Hervey’s list included traits like superficial charm, lack of remorse or shame, inability to learn from experience, lack of any life plan, incapable of love and unreliability. The gap in the perception of psychopaths may be understood from Micheal Hakeem’s observation that psychopathic personality is analyzed by psychiatrists in several different and contradicting ways (McCaghy et al., 2008). He justifies it by stating a few questions and the answers he found for them in the psychiatric literature, summing up his view that psychopathic personality hasn’t been understood evenly.
Childhood behavior disorder and adult psychopathy
Given the fact that adult psychopaths show reduced reaction to negative stimuli, it has been predicted that this response quality would be evident at early ages. A 25 year-old study published in August 2007 in Journal of Abnormal Psychology (Glen 2007) showed that traits associated with adult psychopathy may be present even at the age of three. Adults with high psychopathy scores were found to have been less fearful and higher stimulus seeking when they were of three years of age. The impaired neurocognitive functioning presents true psychiatric disorder in children, which is reflected in their behavioral problems (Duran, 2010). Behavioral problems of children require to be analyzed in depth to understand its later relevance to psychopathy and criminal acts. However it must be noted here that among children identified for conduct and behavior disorder, only a subset of them have been later identified with high levels of psychopathy. The foundations of antisocial behavior are sowed in early childhood. Although some are born with few antisocial tendencies, they are difficult to be controlled.
Behavioral problems refer to those behaviors that are deviated from norms and laws. The Diagnostic and Statistical Manual of Mental Disorders (DSM) which provide the official classification for these problems, defines behavioral problems as conduct disorder (CD). The fourth edition of the manual describes behavioral problems as an integral aspect of the topic ‘disruptive behavioral disorders’. The manual also views CD as aggressive and antisocial acts that include denying other’s rights, inflicting pain and status offenses like running away from home. The oppositional defiant disorder (ODD) however includes less severe behaviors like age- appropriate show of anger, defiance and irritation. The APD is characterized by persistent behavioral problems through adulthood.
Determining the prevalence rates of these behavioral problems is a difficult task for several reasons like lack of proper demarcation and lack of defined identity criteria. However reasonable estimates can be provided in the form of ranges, based on child and adolescent samples. The prevalence of ODD is estimated to range between 1 to 20% while CD is estimated to vary from 1 to 10%. Also males exhibit higher rates of behavioral problems as determined from DSM which suggest CD to be prevalent in about 6 to 16% males. In females it is expected to be prevalent in about 2 to 9%. Recent research has established that manifestations of behavioral problems are also different for males and females.
The role of vulnerability and stress in behavior problem development
Several vulnerabilities and stressful environment contribute to the development of behavioral problems particularly during childhood and adolescence. Although it is difficult to achieve a complete understanding of behavioral problems, based on vulnerabilities and stress factors, some authors have suggested that it would be possible to explain differences in antisocial behavior based on individual differences in antisocial propensity. Stressful environment can strongly influence conduct problems, however to understand how it translates into behavioral problems, one needs to consider the role of vulnerabilities and individual differences in vulnerabilities.
Multiple factors account for antisocial propensity which influences behavior problems developing between early childhood and late adolescence. But the level of influence of these factors varies with age corresponding to the onset of behavioral problems. For children with early onset of behavioral problems, the vulnerabilities for antisocial propensity play an important role in escalating the behavioral problems with time (Hankin et al., 2005). However when the age of onset for behavior problem is comparatively higher; the vulnerabilities for antisocial propensity plays a lesser role in increasing behavioral problems. Here environmental and social factors play an important role in the development of behavioral problems.
Genetic vulnerability in behavior problem development
Antisocial behavior in children and adolescents is considerably influenced by genetic factors, which has been proved by twin and adoption studies. The onset of conduct problems and its prevalence over time are, both influenced by genetic factors. It should be mentioned here that oppositional and aggressive behavioral problems are more influenced by genetic factors while covert behavioral problems and delinquency are less influenced by heredity. However the influence of genetics on behavioral problems can be mitigated by introducing a favorable social learning environment. Also behavioral problems among adopted children of antisocial parents are less when these children are raised by well-adjusted adoptive parents.
Temperament/ Personality vulnerability in behavior problem development
Temperament is a characteristic that is considerably inherited where individual differences are reflected in socioeconomic responses, evident in early childhood. Three aspects of temperament have been recognized as vulnerabilities for behavior disorder according to Lahey (Lahey, 2003):
Negative emotionality: Negative emotionality or neuroticism is associated with several mental health problems including those evident among adults. It is evident when an individual experiences negative emotions frequently or intensely even with little provocation. Studies have determined significant association of conduct problems in child with negative emotionality but have not been consistent in relating these two.
Daring: Daring or sensation seeking refers to youth who are more likely to become chronic offenders during their childhood and adolescence (Farrington & West, 1993). These traits are related to novelty seeking which have been proved to have a positive correlation with conduct problems. An opposing attribute of daring is the ‘harm avoidance’ trait where children are less likely to engage in antisocial behavior. Another attribute that is inversely related to daring is the ‘disinhibition’ trait which is also a prediction for conduct problems in early adolescence.
Prosociality: Prosociality is reflected in youth with more behavioral problems, showing least sympathy and concern for others. Prosocial behavior exhibited at age 8 was later related with criminal offenses at the age of 27.
Attachment styles in behavior problem development
Insecure attachment styles have been studied to be a predictor of behavior problem development in children and adolescents. These are considered to be responsible for non-specific risk in the development of psychopathology. However some studies have obtained mixed findings with regard to linking insecure attachment and problematic behavior development.
Psychopathy and brain structure
The psychopathic behavior has been traditionally blamed on sociological and familial factors. However newer evidence indicates that parenting and environments plays a lesser role compared to their brain. Christopher Patrick et al. determined in 1995 that psychopaths have reduced heart rate changes and skin conductance change when responding to fear compared to others. This indicated that biological processes responsible for emotions are defective in psychopaths, again pointing to the brain.
Subsequent research by Dominique La Pierre suggested that the functioning of prefrontal cortex is impaired in psychopathic subjects. Prefrontal cortex is the area of the brain that is involved in long term planning and judgment (Crime Times, 2007). A study by Rodney Day and Stephen Wong tested bout 20 psychopathic and 20 non-psychopathic inmates. All were shown two words, of which one was associated with negative emotions while the other was a neutral word. The negative word was projected in the right visual field of the subjects and the neutral word in the left visual field. The order was then reversed and shown. It was determined that non-psychopaths perceived the negative emotion words with more accuracy and quicker processing in the left visual field corresponding to right hemisphere. Psychopaths however did not show any considerable visual field advantage. The right hemisphere of the brain is responsible for processing emotional significance of the words. Therefore researchers conclude that psychopaths who are emotionally shallow rely less on right hemisphere-based decoding. Psychopaths are speculated to rely more on the left hemisphere which is associated more with verbal analysis. The processing of emotions by psychopaths may be limited to language, resulting in its abnormal processing.
Modern research also reinforces the view that psychopathy is strongly associated with abnormalities in brain structure. A study undertaken by King’s College, London; describes psychopathy as a neuro-developmental sub group of APD (NeuroScience, 2012). MRI scans on brains of psychopaths revealed structural brain abnormalities compared with those without psychopathy among violent offenders with APD. The study found that those with psychopathy had considerably lesser grey matter at the anterior rostral prefrontal cortex and temporal poles. According to Dr. Blackwood who led the study, these areas correspond to understanding emotions and intentions. When these areas are damaged, there is in impaired perception to people’s feelings and response to external dangers (Szalavitz, 2012). Indentifying psychopaths through brain scans has significant relevance to its treatment.
Psychopathy Checklist (PCL)
Recognizing the need for a reliable method for identifying psychopath individuals, Hare developed a reliable assessment tool after over a decade of research. The developed tool was regarded as the Psychopathy Checklist (PCL) and did not rely on self-reporting. This tool has since been widely used in assessing psychopathy in professional circles.
According to the developed tool, the key symptoms of psychopathy are:
Grandiose perception of self worth
Lack of empathy
Being deceitful and manipulative
Improper behavior control
Lack of responsibility
Early behavioral problem and
Adult antisocial behavior
The list has undergone revisions and refinement and the revised version Psychopathy Checklist-Revised (PCL-R) has been formed, which has been proved to be more reliable and consistent in assessment of convicted criminals. The PCL-R evaluates these traits on a clinical rating scale of 20 attributes, and each item further graded on a three point scale with either 0, 1 or 2, based on structured interviews and personal information available on personal file. Based on the scores obtained, risk for criminal reoffense and the effectiveness of rehabilitation is predicted.
Treatment and recidivism
The treatment associated with psychopathic disorder has been largely surrounded with controversy among the treating psychiatrists until the end of the previous century. The controversy surrounds the classification of psychopathy which has dampened the efforts to treat its syndromes. Cleckley in his book ‘The Mask of Sanity’ drew attention to the fact that there has been a lack of success in efforts to treat typical psychopaths. He also highlighted the characteristics of the disorder that rendered it unapproachable and unmanageable. Subsequently more psychiatrists have doubted on their ability to offer treatments for this group.
This controversy may be considerably attributed to the differences among clinical psychiatrist and psychologists on three important issues:
1) The nature of psychopathic condition and the specific groups to whom it is applicable.
2) Identifying the goals and targets for the clinical management of the disorder
3) The extent to which these disorders are treatable.
Psychopathic individuals are generally viewed as incurable and could be benefitted when moved from treatment settings to facilitating environments, where their behavior can be controlled and monitored. The current clinical conviction that psychopaths are untreatable has huge implications, given the extensive research on psychopathy reflecting the violence risk associated with them. Psychopathic traits also do not influence the effect of treatment outcomes on violence (Skeem et al., 2002). These patients are as likely to benefit from adequate doses of treatment for violence reduction, as non-psychopathic patients.
A treatment model developed by Dr. Henri Van der Hoeven emphasizes on reducing violence risk by controlling patient behavior and insight. The treatment program includes individual and group psychotherapy, education, sports, creative arts and job training. Patients are also required to participate in impulsivity management, aggression and social skills training.
Several researchers have evaluated the ability of PCL-R in predicting recidivism in various clinical settings. It was determined that PCL-R consistently predicted recidivism in various clinical settings. These results have motivated researchers to determine the possibility of a relationship between psychopathy and treatment outcomes among the incarcerated population. With regard to recidivism of psychopaths, it should be noted here that on an average, psychopaths account for 20% of prison inmates; however they represent about 50% of violent crimes.
Studies on federal prisoners, focusing on their recidivism rates have shown that psychopaths have a reoffense rate that is twice that of the other offenders and a violence recidivism rate that is about thrice that of the others. In general, it has been observed that reoffending males and adolescents psychopaths with high PCL-scores show a significant negative response to treatment. A study undertaken by Ogloff, Wong and Greenwood in 1990 also determined that those with a score of ≥ 27 showed reduced motivation and reduced clinical improvement. They were also found to be highly likely to terminate their participation in the treatment program.
According to Hare, there have been several intensive programs directed at the transformation of incarcerated psychopaths, but that no program has yet been effective. He however notes that therapy can help psychopaths to manage their manipulative skills.
Psychopathy is a personality disorder, clinically regarded as a form of ‘Antisocial Personality Disorder’ or APD. The term is often used interchangeably with ‘sociopath’ when describing individuals with APD. Although the population affected by APD may be even as high as 85%, only about 20% of them could be diagnosed as psychopaths. Psychopaths are charming and are focused on gaining from calculated efforts at the cost of others, while only a small percentage of them are actually violent offenders. The identification and treatment of psychopaths is shrouded in confusion, due to lack of consensus among psychiatrists on clinical diagnosis and recidivism of psychopathy . The Psychopathy Checklist (PCL) and the revised checklist (PCL-R) have however proved to be more reliable and consistent in psychopathy assessment.
Adult psychopaths have their psychopathic traits associated to childhood behavior problems and conduct disorder. Several attributes of vulnerabilities and stress experienced during childhood, render them prone to becoming psychopaths in their adult life. Newer evidence indicates that psychopathy is strongly associated with abnormalities in brain structure, which impair their ability to experience emotions. Psychopathic individuals are generally viewed as incurable but could be benefitted when moved from treatment settings to facilitating environments.
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