How Psychopaths Work

Eighteenth-century French physician Phillipe Pinel was among the first medical professionals to describe psychopathy, a condition that he referred to as maniaque sans delire, or "insanity without delirium." Other 19thcentury doctors recognized the affliction as well, describing it as "rational madness," "moral derangement," or "moral insanity." Then, in 1888, German psychiatrist J.L.A. Koch jumped in with a term of his own: psychopastiche, a German word meaning "suffering soul" — and the word "psychopathy" was born. It gained some clinical use in the early 1900s before the word "sociopathy" supplanted it in the 1930s, apparently to avoid confusion with another condition, psychosis. Sociopathy also suggested the influence of social and environmental factors in causing the disorder, which was a popular opinion at the time.

The current terminology emerged in 1980 when the Diagnostic and Statistical Manual of Mental Disorders (DSM), which lays out the standard terminology for they psychiatric profession, shed the term sociopathy in favor of the broader condition "antisocial personality disorder" (ASPD). Today, the descriptors "psychopath" and "sociopath" are still common and often used interchangeably because they denote the same personality traits.

But there is a difference, and it lies in the cause: Psychopaths present callous, unemotional tendencies because of physical abnormalities in the brain, while sociopaths show these same qualities as a result of social influences. Similarly, the terms "primary psychopath" and "secondary psychopath" denote this same physical/environmental divide. So when psychiatrists say "sociopath" or "secondary psychopath," they're essentially referring to the same thing [source: Hirstein].

Despite the publication of two new editions of the DSM since 1980, psychopathy is still relegated to the broader ASPD category. It's a sore point for many psychopathy specialists who are quick to point out that the two conditions are not the same, and, in fact, only 1 in 5 people with ASPD are psychopaths [source: Kiehl and Buckholtz].

Now that we've established the history and vocabulary of psychopathy, let's dig a little deeper into the characteristics of the disorder.

A good place to start is with demographics. Do age, race or gender play a role in psychopathy? The answer is a little tricky because psychopaths, by their very nature, aren't likely to admit to having a problem. Without any self-reporting, researchers instead have to rely on survey data gathered largely from criminals who are compelled to undergo psychiatric examination. Conclusions based on such data are often uncertain at best or controversial at worst.

Studies related to age and race are particularly cloudy. One analysis on age, for example, showed that some psychopathic traits appear to decline as patients get older, though it's unclear why [source: Harpur and Hare]. Researchers also disagree about whether children can be considered psychopaths at all. While some studies suggest that infants and toddlers can express traits associated with psychopathy, children can't technically be diagnosed with the disorder, and such traits don't guarantee they'll become psychopaths as adults [sources: Harrold, McLain, Ossola].

More contentious are studies relating psychopathy to race. Such analyses — particularly those that have tried to link high rates of the disorder to African-American and Native-American communities — have been heavily criticized in the psychiatric community as racist and dismissive of socioeconomic factors [sources: Lynn, Zuckerman].

Gender, on the other hand, appears to have a pretty clear influence on psychopathic traits. Women consistently score lower on psychopathic evaluations, a finding that holds up even among violent criminals. One study of a prison population, for example, pinned the occurrence of psychopathy at 11 percent for women versus 31 percent for men [source: Wynne et al.]. Still, some researchers dispute this claim, suggesting instead that women simply express psychopathic traits in a way that overlaps with other conditions, like borderline personality disorder (BPD). According to this theory, women typically diagnosed with BPD — particularly those who swing between extreme emotional responses and callous, manipulative behavior — may just have a female version of psychopathy [sources: Johnston and Sprague et al.].

While the demographics of psychopathy may be little murky, the behaviors are pretty well established. The Hare Psychopathy Checklist, the most widely used diagnostic tool for the disorder, lists 20 characteristics: glibness and superficiality, grandiosity, need for stimulation, pathological lying, cunning and manipulativeness, lack of remorse or guilt, emotional shallowness, callousness and lack of empathy, parasitic lifestyle, poor behavioral controls, sexual promiscuity, early behavior problems, lack of realistic long-term goals, impulsivity, irresponsibility, failure to accept responsibility, multiple marriages, juvenile delinquency, revocation of conditional release (like parole violations), and committing a variety of crimes [source: Kiehl and Hoffman].

While someone afflicted with these horrifying traits might seem easy to pick out, psychopaths are actually quite good at hiding them. Still, there are some giveaways. Part of what makes them so hard to pin down is their charm. They're great conversationalists and are generally quite likeable. But things can turn dark when their lack of conscience and empathy shows through; psychopaths will often do harmful things to others and refuse to accept responsibility. Instead, they'll blame others and continue do whatever it takes to achieve their objective. Another giveaway is their ability to use people's emotions against them, using guilt trips, flattery and sympathy to get what they want. As if all that isn't bad enough, psychopaths don't think rules apply to them. They think they can get away with anything because they're smarter and more important than anyone else [source: Morin].

Right now you may be thinking, "Wait, I know someone like that." And you might be right. Psychopaths aren't all serial killers or even criminals. Sure, they're overrepresented in the prison populations, making up some 25 percent of that group even though they're only 1 percent of the general population [source: Wynn et al.]. But with 3 million in the United States, there are plenty of psychopaths functioning as productive members of society. Some researchers even suggest that psychopathic traits help people succeed in some professions, like politics and finance. One study of the financial services industry, for example, suggests the profession's rate of psychopathy could be as high as 10 percent! That's not surprising, though, when you consider how characteristics like superficial charm, the ability to handle high-pressure situations, the desire for power and a willingness to take risks might be beneficial in these professions. It's no wonder Churchill and Kennedy might've had a touch of the disorder [sources: Silver, "Wall Street"; Silver, "Politicians"].

If you think you know a psychopath, resist the temptation to engage with his manipulations; that's what he wants you to do. Instead, accept that psychopaths are just damaged people whose actions are more meaningful than their words. They'll throw you under the bus if they need to, so guard your reputation, and if you have to, propose strategies in which you both win. In the end, though, it's best just to say away [source: Barker].

One of the biggest challenges in studying psychological disorders is that they often result from a complex mix of physical and social factors, and psychopathy is no exception. An analysis of identical twins in Minnesota suggests that the disorder is at least 60 percent determined by genetics, though other sources peg the number closer to 50 percent [sources: Brogaard, Kiehl and Buckholtz]. Either way, it's clear that both factors play an important role.

Identifying social factors has proven to be a difficult task for researchers. Studies have shown that absent fathers and physical neglect in childhood are strongly associated with psychopathic characteristics in adults, but there's no proof that these factors actually cause the disorder. In fact, many of the United States' most notorious psychopathic serial killers — including Ted Bundy and Dennis Rader — grew up in healthy, supportive households. The challenge of positively identifying social factors is that it's difficult to isolate them from physical ones. For example, a psychopath may have been neglected by his father, but it's hard to tell whether the neglect caused his disorder or was an indicator that his father was also a psychopath [sources: Wallisch, Brogaard].

Clearly, social factors can only explain so much. So what's actually going on in the physical structure of a psychopath's brain? Like many questions about the brain, the answer is complicated. Scientists first suspected damage to the frontal lobe, which among other things processes risk, reward and punishment [sources: Kiehl and Buckholtz, Brogaard].

More recent research, however, has shifted to the brain region known as the paralimbic system. These new findings came about thanks to a technology called functional magnetic resonance imaging, or fMRI, which allows researchers to see to what extent different parts of the brain are being used. As it turns out, psychopathic brains show significantly less activity in the paralimbic system than normal brains, which means it's underdeveloped. So why is this important? The paralimbic region controls moral reasoning, emotional memories and inhibition — in other words, exactly the kinds of characteristics lacking in psychopathic behavior [source: Kiehl and Buckholtz].

Psychopathy is incurable. No one knows how to repair the damaged areas of the brain largely responsible for the disorder. But thanks to advancements in diagnosis and treatment, there may be hope for some improvement, particularly if the condition is detected early in life.

The big breakthrough in diagnosis came in 1980, when psychologist Robert Hare developed the Psychopathy Checklist (PCL), a list of 20 traits he attributed to psychopathy. This is how it works: Psychologists ask patients a series of questions to determine whether they possess the traits. If the trait is present, they get two points, and if it's not, they get zero. If the psychologist isn't sure, they get 1 point. The max score is 40, but anything over 30 means the patient is a psychopath.

The test, which was revised in 2003 and is now known as the PCL-R, works surprisingly well. One study showed that while 80 percent of high-scoring criminals reoffended within four or five years, the percentage dropped to 20 or 25 percent among low-scoring criminals. That success, however, has a potential downside: The PCL-R is now used in the parole process to predict whether a criminal will reoffend, keeping otherwise well-behaved criminals in prison indefinitely. It's a use bemoaned by many mental health professionals, including Hare himself [source: Spiegel].

Once someone is diagnosed with psychopathy, treatment options are limited, but not non-existent. In the past, traditional methods like group therapy not only haven't worked, but they've made the problem worse. Surgery, electroshock and drugs were hardly better, producing wildly mixed results. Recent experiments, however, have shown some success, particularly among children.

One promising method, known as decompression treatment, is based on the notion that psychopaths respond better to rewards for good behavior than punishment for bad behavior. In this technique, which involves daily, hours-long sessions of close supervision, psychologists gradually increase rewards for good behavior in an effort to speak to the psychopath's desire to win — and it seems to work. One study of incarcerated boys showed that after two years, only 52 percent of those receiving decompression treatment reoffended compared to 73 percent who received traditional group therapy [source: Kiehl and Hoffman].

Still, there are limitations to treatment. Because the greatest successes seem to come from treating younger patients, older psychopaths are left with few options. And even if there were more options, it's unclear how you would get psychopaths outside the prison system to seek treatment. In their minds, they don't need help; their personality actually makes them better than everyone else.