The studies behind the cultural obsession.
Is there any other mental health condition that receives such dark glamour as psychopathy?
As a culture, we’re obsessed.
- We joke about what “psychos” we are for loving serial killer documentaries.
- The main character from You, a murderous stalker, is also a sex symbol.
- The Kubrick stare is famous.
- For the current President of the United States alone, the debate on whether or not he’s a psychopath could probably fill a book.
(I’ll let you draw your own conclusions on that last one when we go over the symptoms.)
Cutting through the cultural myths to the actual science is hard — especially when the media is quick to label any violent criminal, rapist, or murderer a psychopath as a freebie catch-all for “bad person”.
In this story, we’re going to look at:
- The definition, symptoms, and diagnostic criteria for being a psychopath.
- What the latest neuroimaging studies tell us about why this occurs.
- Some FAQs of common things people get wrong about the disorder.
What is psychopathy?
Psychopathy is another name for severe anti-social personality disorder (ASPD). Rarely is anyone diagnosed with “being a psychopath” outside of the prison system — instead, they receive a diagnosis of ASPD.
Throughout this story, I’ll refer to a “person with a severe anti-social personality disorder” interchangeably as a “psychopath”, since the term is better known and established.
Diagnostic criteria
In the DSM-V, the key traits of anti-social personality disorder are:
- Ego-centrism. A psychopath’s primary concern is themselves. Their primary goal is to maximise their personal pleasure, and they often derive satisfaction from gaining powers over others. Rather than help others, or comply with the law, because it is the “right” thing to do, a psychopath will instead only undertake these actions when it is of benefit to them.
- Lack of empathy for others. Psychopaths experience no empathy for others normally but can “switch” this on at will. Non-psychopaths will feel emotionally distressed on some level when witnessing a human being, child, a small animal in pain — even if they wish they didn’t. Psychopaths are the opposite and do not care as a default setting.
- Lack of intimate relationships. Relationships are pursued for personal gain, devoid of feelings of love or affection. Psychopaths present most similarly to the avoidant attachment style in relationships. They struggle to maintain close, genuine friendships/romances.
- Anti-social behaviour. Psychopaths are pathological liars, deliberately charm and manipulate others, and are prone to aggression and sadism.
- Recklessness. Most psychopaths have poor impulse control. They engage in impulsive decisions, risk-taking behaviour, and illegal activity at a greater rate than the general population.
The second dominant method of assessing psychopathy is the Psychopathy Checklist of 22 items, often used within prison populations.
It has a higher threshold for meeting the diagnostic criteria: only ~25% of people with ASPD also meet the checklist’s definition of a psychopathy.
The Psychopathy Checklist includes traits that overlap with the above — eg. impulsivity, ego-centricity — while also including specific behaviours, eg. juvenile delinquency and a history of multiple offences.
Prevalence
ASPD has a prevalence rate of between 0.2–2% in the world population. It is more common in men, and drastically more common in prisons — at around 15–25% of the inmate population.
It also varies between countries and cultures: people in rural communities, for example, tend to have less psychopathic traits. Within the United States, a study suggested the Northeast had the greatest prevalence of psychopathic traits — hello, New York stereotypes!
The neuroscience
Psychopathy is a complex brain disorder. There is no single “psychopath gene” or specific brain area we can isolate and “fix”.
The main two brain regions implicated in psychopathy are the ventromedial prefrontal cortex and the amygdala.
The ventromedial prefrontal cortex (vmPFC) is involved in how we process emotive information to make decisions. (It’s located at the bottom of the frontal lobe — right over the insides of your nose!) It regulates our emotions, developing during adolescence so we emerge less reckless and temperamental.
Damage sustained to the vmPFC, such as via head injury, is associated with an abrupt personality change. Post-injury traits include rude and anti-social behaviour, as well as struggling with moral judgements. (Phineas Gage was the most famous, and catastrophic, early example of this.)
When studied, people with psychopathy struggle to inhibit and “stop” previously rewarding actions. They also take greater risks when gambling. Both are associated with poor vmPFC functioning. Outside of a lab, this translates to the real-life actions of those with psychopathy — they are more likely to live a “parasitic lifestyle”, and to risk arrest.
The amygdala is an almond-shaped cluster of neurons located deep inside the brain, associated with experiencing emotion: particularly anxiety and fear. Psychopaths have, on average, 18% smaller amygdalae compared to non-psychopathic controls. Children as young as three years old who demonstrate a lack of learned fear response — for example, not avoiding a corner where a snake previously jumped out at them — and are callous towards peers are at greater risk of growing up to be diagnosed with ASPD.
Deformations and shrinkage in the amygdala, the emotive centre of the brain, explain psychopaths “icy” lack of emotionality in their behaviour and interactions with others. Psychopaths showcase a lack of feeling in response to others, alongside a lack of fear in threatening situations. This is also called fearless dominance.
Connections between these two areas — the vmPFC and amygdala — are weakened in psychopathy. In brain scans of criminal psychopaths vs. criminal non-psychopaths, those with a diagnosis of psychopathy had less white matter linking the vmPFC with the amygdala.
FAQs
Is psychosis the same thing?
While the names are similar, psychopathy is distinct from psychosis. A psychopath has the traits listed above. Somebody with psychosis experiences delusions/hallucinations. While it’s possible to have both, these are completely separate diagnoses.
What about psychopaths vs sociopaths?
Debates around sociopathy vs. psychopathy are fairly common in popular culture, and unsettled within psychology as a discipline. Personally, and for most psychologists I know, ASPD is ASPD is ASPD. Both potential subtypes are included under this diagnosis without hair-splitting. So far, any psychopath/sociopath distinction has received little empirical support.
Are psychopaths “evil”?
This depends on what your definition of evil is.
Psychopaths tend to break social/ethical norms. Their actions are more likely to hurt people, and to react uncaringly when this happens. We generally perceive this as evil.
On the other hand, psychopaths themselves lack this internal “code” of empathy.
For them, behaving ethically is a little like trying to sing the same song if nobody gave you the hymnsheet.
Can psychopathic traits be beneficial?
The vast majority of psychopaths are not axe-wielding serial killers.
Anti-social traits can be “high-functioning” and beneficial or even sought after in some professions, where they are over-represented: such as in CEOs and surgeons.
Am I a psychopath?
Honestly, if you’re worrying about it, probably not. Everyone’s level of empathy exists on a sliding scale of low — high, but rarely ventures into pathological deficit.
It’s far more likely to a) want to be a psychopath for some edgy credentials / the appeal of being less emotionally vulnerable, or b) worry that you’re a psychopath for screwing up and not caring about somebody that one time, than it is to be a psychopath. Sorry/congratulations!
Can psychopathy be cured?
The stock answer is no. There is no pill or therapy currently developed to treat psychopathy. The clue is in the name: anti-social personality disorder. Personality disorders are life-long.
The main issue, beyond the complexity of the disorder, is that psychopaths are not motivated to change.
Most of the time, we treat people who want to be treated because their mental health is causing them subjective distress. The depressed individual doesn’t want to feel sad anymore. The agoraphobe wants to be able to leave the house again. Psychopaths aren’t distressed by their lack of empathy.
There is some recent research evidence for the Decompression Model helping the young criminal psychopath. In it, pro-social behaviour is reinforced by reward. This makes other people’s interest — being unharmed and treated with respect — the psychopath’s self-interest, too, as they receive a tangible benefit to themselves, such as the right to play video games. Participants who received these rewards were 34% less likely to re-offend.
So, the more nuanced answer: Psychopathy isn’t curable — but it may be treatable.
If you have any suggestions for “This Is Your Brain On…” topics you’d like to see in the future beyond psychopathy — in the past I’ve covered ADHD and lucid dreaming — simply hit me up in the comments below! I’ll read each of them, and see what I can do.
Thank you for reading. Take care of your brain out there.
