Psychopathy

The term ‘psychopathy’ has a complicated history and brings with it a range of unhelpful preconceptions and harmful stereotypes. The term alone is no longer used as a diagnosis, but it is used by professionals to describe certain traits found in mental health problems like antisocial personality disorder.

What is psychopathy?

The term ’psychopathy’ is used in different ways and its use has changed over time, which can make it difficult to define.

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) ^[1] is used by mental health professionals in the US to diagnose mental health problems. The DSM-5 no longer uses ‘psychopathy’ as a diagnosis. It appeared in the first two editions, but was dropped in the third edition to be replaced by antisocial personality disorder (ASPD)^[2].

The previously known definition of psychopathy can be found in DSM-5 as a symptom of ASPD. It is used to describe the central feature of ASPD, which is a ‘pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood’.^[1]

The not-for-profit organization Psychopathy Is was established 2020 and is led by professionals hoping to raise awareness and understanding of psychopathy. It describes psychopathy as ‘a common mental disorder […] characterized by personality traits that include reduced empathy and remorse, a bold and daring personality, and difficulty inhibiting behaviors’.^[3]

Psychopathy and stigma

Psychopathy has long been associated with serial killers and other violent individuals, perpetuated by news reporting and in popular culture. This contributes to the stigma surrounding psychopathy specifically and mental health problems more generally.

While having psychopathic traits does increase a person’s tendency toward antisocial behavior and (in some cases) aggression, it is by no means true that all people with psychopathy are violent and likely to hurt others.^[3] For many, a ‘disregard for others’ rights’ may take the form of stealing or lying, rather than any kind of violence or aggression. Conversely, there are many people who are violent who don’t meet the criteria for psychopathy.^[3]

The word ‘psycho’ is commonly used informally to describe people who are erratic, aggressive, and violent. On top of this, confusion between the word ‘psychopathy’ and ‘psychotic’ mean that people experiencing psychosis are affected by this same stigma.^[4]

The stigma that surrounds mental illness has a huge impact and can prevent people from opening up and seeking help for their condition.^[5] The ‘psycho’ stereotypes unfairly brand people with mental health problems as dangerous, when, in reality, the overwhelming majority of people with mental health problems are no more likely to be violent that those without.^[8]

The anti-stigma campaign Make It Ok has information and resources to help people break down stigma and raise awareness of mental health problems.^[6]

Psychopathic traits

According to the organization Psychopathy Is, the main traits of psychopathy are:^[7]

• An ‘uncaring temperament’: This might come across as behavior that causes others harm (physically, emotionally, financially, etc.), a lack of remorse or concern, lying and manipulation, coldness, indifference, and insincerity.
• Excessive confidence: This can present as arrogance and risky behavior without regard for the consequences.
• A lack of inhibitions: This may be characterized by a tendency to bore easily and act spontaneously, breaking promises, and failing to deliver on commitments like employment in the process.

Psychopathy can be viewed as a spectrum, with some people experiencing it more severely than others. It is believed to affect around 1 in 100 people worldwide.^[3]

Illnesses linked to psychopathy

Antisocial personality disorder (ASPD) replaced psychopathy in the third edition of the DSM-5 but can only be diagnosed in adulthood. Children displaying similar behaviors may be diagnosed with ‘conduct disorder with limited prosocial emotions’.

Antisocial personality disorder

Antisocial personality disorder (ASPD) is a mental health problem where the central feature is psychopathic traits. It can only be diagnosed in people over 18 and there must be evidence that symptoms have been present since before the age of 15.^[1]

Conduct disorder with limited prosocial emotions

Conduct disorder is a diagnosis given to children displaying early signs of behavior that violates the rights of others or normal social rules. Symptoms might include bullying, cruelty to animals, starting fires, stealing, and truancy. The behavior must be persistent and have a significant effect on the child’s life.^[1]

There are different types of conduct disorder. ‘With prosocial emotions’ means that the child has additional symptoms, which may include a lack of remorse, a lack of empathy, indifference to concern about academic performance, or appearing insincere or shallow.^[1]

Treatment

Antisocial personality disorder, conduct disorder, and psychopathic traits are all treatable.

For children

In children, family-focused therapy has proven to be effective, where a mental health professional will work with the child and their parents or caregivers to understand and manage the condition in the home.^[9]

Medication can also be prescribed, usually medication for attention deficit hyperactivity disorder (ADHD), a mood stabilizer, or an anti-anxiety medication. Medication should only be used in combination with therapy.^[9]

If therapy and medication prove ineffective, treatment in a residential facility may be a next step.^[9]

For adults

In adults, one-to-one therapy can be effective. This may include cognitive behavioral therapy (CBT), which looks at how what we think and feel affects how we behave. CBT is widely available. There are other, more specialized therapies that may be effective for antisocial personality disorder, but they are less widely available. These include Risk Need Responsivity (only available in a detention setting), Scheme-Focused Therapy, and Transference-Focused Therapy.^[10]

Psychopathy and psychosis: What’s the difference?

Despite sounding similar, psychopathy and psychosis are different.

Psychosis is the term used to describe a set of symptoms that indicate someone has experienced a break from reality. The two main symptoms of psychosis are hallucinations (seeing or hearing thing that aren’t there) and delusions (beliefs that aren’t real, usually that one is being watched, followed, or going to be harmed).^[11]

People can experience a one-off episode of psychosis, or it may form part of a diagnosis for a mental or physical illness. Psychosis is a feature of schizophrenia and bipolar disorder, and it can also affect people with dementia and brain injuries. It can also be caused by taking certain substances including cannabis, cocaine, and meth. Some people experience psychosis when coming off alcohol or certain medications such as sleeping tablets.^[12]