Psychopaths or psychopathic personality disorder currently fall under the guise of antisocial personality disorder (ASPD). While it is true that not all people given the diagnosis of ASPD are psychopaths, there are many overlying factors between the two groups. It was once posited that psychopaths were rare; however, in today’s society psychopaths are quite common. They can broadly be divided into two categories:
- The successful psychopath, often found in boardrooms
- The psychopath commonly seen in the criminal justice system
In an effort to assist licensed professional counselors, this article will introduce key characteristics of both types of psychopaths, providing various interviewing techniques used to build rapport and elicit more information for assessment and diagnostic purposes. In part two of this two-part series, several case studies will be presented to facilitate the understanding of the treatment recommendations.
Antisocial Personality Disorder, Psychopathy, and Sociopathy
The terms “antisocial personality disorder,” “psychopathy,” and “sociopathy” are commonly referred to synonymously; however, there appears to be some confusion about the use of terminology that requires examination in order to assist mental health practitioners. The Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) is the prevailing reference for mental disorders in the United States, and it outlines the criteria for all personality disorders (APA, 2013). Personality disorders are defined by their persistent and pervasive patterns of characteristics and behaviors and are classified into three categories in the DSM-5: cluster A, cluster B, and cluster C—these clusters often have overlapping characteristics (APA, 2013). For the purpose of this paper, we will focus on cluster B. Cluster B is often referred to as the emotional, erratic, dramatic cluster and it encompasses all criteria for ASPD. While the term “psychopathy” is included in the DSM-5 as an alternative model under ASPD, clarification needs to be distinguished between ASPD, psychopathy, and sociopathy (Thompson, Ramos, & Willett, 2014).
The main distinction between these conditions lies within their behavioral versus their personality components. According to Ogloff, Campbell, and Shepherd (2016), in order to meet the diagnosis for ASPD individuals must exhibit a persistent behavioral pattern of violation or disregard for others’ rights, act in a neglectful manner regarding others’ safety, and often exhibit deceitful and manipulative behavior. In addition, individuals must also have evidenced conduct disorder prior to the age of fifteen. These behaviors often include violence or other criminal behavior, and largely focus on actions perpetrated by individuals. In contrast, according to Thompson et al., “psychopathy and sociopathy are dispositional conditions that primarily emphasize personality traits” and these traits can be divided into two groups of factors, commonly referred to as “factor one” and “factor two items” (2014, p. 485). Furthermore, psychopathy and sociopathy can be distinguished when identifying the differences between primary and secondary psychopaths, as there are discrepancies in both their cognitive and affective realms. Thompson et al. (2014) stated that the characteristics associated with primary psychopaths are largely biological; inherited; include affective deficits such as absence of negative emotions and low levels of anxiety; and an increase in confidence, whereas secondary psychopaths acquire their characteristics through socialization; include affective deficits; and often exhibit emotional disturbances, hostility, withdraw, and high levels of anxiety. Secondary psychopaths are referred to as sociopaths. Moreover, according to Thompson et al. (2014), one final distinction between psychopaths and sociopaths is their scores on the Psychopathy Checklist Revised (PCL-R), as primary psychopaths have a higher factor one item score in contrast to secondary psychopaths, who score higher on factor two items (see Table 1). The distinction between ASPD and psychopathy can also be gleaned from PCL-R scores as, according to Pardue, Robinson, and Arrigo (2013), individuals with a high score on the PCL-R—generally twenty-five to thirty and above out of a total of forty—regularly also meet the DSM-5 criteria for ASPD. However, individuals who have met that diagnostic criteria frequently do not obtain high PCL-R scores. Pardue et al. provided percentages to further the differentiation, stating “whereas the vast majority (about 90 percent) of criminals classified by the PCL-R as psychopathic are diagnosed with ASPD, only about 30 percent of those with the diagnosis of ASPD can qualify as psychopathic” (2013, p. 133). In addition, Ogloff et al. (2016) research indicated differences in the prevalence as percentage of the general population meets the criteria for ASPD and that rate increases to 30 percent within civil psychiatric realms, and drastically rises to 80 percent in the forensic and correctional settings whereas less than 1 percent of the general population meets the criteria for psychopathy. However, there is a rate of 15.7, 10, and 7.4 percent for male offenders, forensic psychiatric patients, and female offenders respectively.
General Overview of Psychopathy
Psychopaths may represent the full spectrum of humanity irrespective of race, culture, geography, economic class, or personality type. Most people think of psychopaths as rare creatures found in the lowest levels of society, but the reverse is true. They are not rare, but actually quite common and can be evenly distributed throughout society. Interestingly, in addition to being divided into primary and secondary psychopaths, psychopaths can also fall broadly into two other categories: those who are more likely to be found in the boardroom (commonly referred to as “successful psychopaths”) and those who have faced the criminal justice system. According to Stevens, Deuling, and Armenakis (2012), the term “successful psychopath” is used to describe individuals in society who possess—to some degree—psychopathic traits, but who have not faced the criminal justice system. Furthermore, Stevens et al. reported that these individuals often seek higher education, particularly in medicine, law, or business, in order to satiate their need for power, control, and wealth (2012). The reason is the more competitive the particular environment, the more ruthless the use of a cheating strategy becomes. Within the highest circles of power and wealth, the lack of pity and remorse is practically a prerequisite to success, and often only the psychopathic mentality can survive. Pardue et al. (2013) reported that behaviors associated with psychopathy are not only frequently tolerated and normalized, but also encouraged as the deviance that commonly occurs in corporations yields to a vast increase of monetary gain, even though the behaviors are often harmful financially, physically, and morally, at times to the point of denying basic human rights. While there is a paucity of research on successful psychopaths due to the uncooperative nature of the business organizations, Pardue et al. reported on one study of 140 participants measured for successful performance in addition to psychopathy, finding 80 percent of the participants scored between zero and three (2013). However, nine scored twenty-five, eight scored at least thirty, two scored thirty-three, and one scored thirty-four; each of these nine scores fall within the high range of psychopathy. Pardue et al. reported their positions within the organization were two vice presidents, two directors, and three which held management or supervisory positions (2013). While it was noted that successful psychopaths share no common characteristics with common criminals other than their gender of male, the behaviors they exhibit, and perhaps the underlying personality characteristics, they seem to overlap extensively, causing overt actions that are also harming society.
According to Coid and Yang, “psychopathy is a personality disorder defined by interpersonal, affective, lifestyle, and antisocial traits with serious, negative consequences for society and an especially poor prognosis among the mental disorders” (2008, p. 773). Because of these serious negative consequences all types of psychopaths have on society, it is vital for clinicians to be aware of their existence and to recognize their behavior traits. Understanding them is the first step in interviewing them for diagnostic purposes. They may present in a manner that looks, feels, smells, and sounds natural and good, but upon more in depth examination what we see is not what we get.
Lack of Empathy
Empathy can be described as our ability to identify and imagine another’s thoughts and feelings, to share similar feelings (especially if people are in distress or experiencing negative emotions), and to match the nonverbal posturing of another (Lishner et al., 2012). Empathy is the ability to experience within oneself the feelings and emotions expressed by humanity. Empathy allows us to experience the grandeur of life, to be truly alive, and it is one of the defining characteristics of what makes us human. In direct contrast, lack of empathy is one of the primary defining characteristics of psychopaths. According to Lishner et al. (2012), psychopaths have an extreme amount of difficulty identifying subtle emotional cues in others, especially those associated with distress, and have very low physiological reactivity when another expresses those emotions, whereas Brites (2016) stated psychopaths simply disregard the significance of another’s emotions and experiences. Psychopaths have no empathy and, as a result, are neither truly human nor truly alive. When they see other people playing with their children, caring for a pet, or any number of human emotional interactions, they cannot understand the encompassing emotions associated with these interactions. Psychopaths realize at an early age that they are different, and that they should act as everyone else does in order to be accepted into society. They learn to mimic what they see others do, but they never understand why they should act this way.
Although psychopaths are consummate actors, careful observation will reveal telltale cracks in their facade. They know enough to fake concern when someone is sick or to pretend happiness when some good fortune befalls a friend. But in situations when the psychopath has no pre-rehearsed act, their adlib often reveals a stunning lack of empathy. For example, when attending a funeral a psychopath will mimic the same expressions of sadness as the other mourners, but then may make sexual advances towards the grieving widow, clueless to the gross inappropriateness of such an action. People with empathy would instinctively understand such behavior as inappropriate, but psychopaths cannot.
Therefore, when interviewing psychopaths, we must be cognizant of not teaching or encouraging them to learn from the interview. For example, we may have gleaned from the interview or the material presented to us that subjects did emotional or financial harm to their alleged victims. When asked by interviewers, “Didn’t you feel bad or experience and guilt or shame for the harm you caused?” this interaction may indeed teach subjects what we and society expect from a person committing harm to another. Psychopaths may learn from this experience how to answer this question in later interviews that provide the more “normal” response. Interviewers therefore may not be able to determine if psychopaths felt guilt or remorse, or if they only learned how to respond from prior interviews. It is important that clinicians not ask leading questions in order to prohibit psychopaths from learning the appropriate empathetic response. This will decrease the likelihood of being able to feign the response and allow for more true information to be acquired.
Lack of Remorse or Guilt
Remorse is an emotional expression of personal regret felt by people after they have committed an act which they deem to be hurtful, shameful, or violent. Guilt was defined by Pardue et al. as “the private feelings of a troubled conscious caused by a personal wrongdoing or by disadvantaging a valued other” (2013, p. 134). These very definitions preclude psychopaths from experiencing such feelings. With no empathy there can be no emotional expression, nor can psychopaths feel shame or comprehend that anything they do can be harmful to others. Psychopaths understand when people are angry with them for their behavior, and as a last resort they may present as apologetic. But unlike most people, they are not the least bit disturbed by feelings of guilt.
Remorse is a powerful negative emotion that causes turmoil for those who feel it—turmoil that often results in self-destructive or self-deprecating behaviors. Psychopaths may feign remorse, but their real behavior is not changed. They still go shopping, they still go to parties, and they have no problems sleeping at night. Lack of guilt with regard to psychopathy is commonly referred to as being “callous-unemotional” (CU) in literature. According to Kauten, Barry, and Leachman (2013), CU entails individuals having a restricted range of emotional responses, being absent from any guilt, and having no empathy for others. Kauten et al. furthered their discussion by highlighting the importance of understanding these traits when working with individuals with psychopathy, as there is a high correlation between CU and violence and aggression (2013). Thus, it is imperative that treating clinicians be aware of the propensity for these destructive behaviors, both within the therapeutic realm as well as their consequences to society.
When psychopaths are asked about their feelings (or lack thereof) about the deed that resulted in the sadness and loss of their victims, if interviewers are highly skilled and aware of not teaching what is expected from society, we may glean a more accurate assessment of the psychopath’s true nature. Conversely, if we evidence what is expected by societal norms, we may only garner a parroting or rehearsed response that he learned was expected. The use of open-ended questions can help assessors gather more information, while simultaneously not leading psychopaths to the most appropriate answers.
Despite being shallow and superficial, psychopaths show no self-esteem issues. Psychopaths live in a falsely constructed worldview in which they are both literally and figuratively God. Often seen as megalomaniacs, they also have an equally overblown sense of entitlement. Psychopaths demonstrate grandiosity and will typically have a high need and desire to be admired, will be envious of others and therefore exploit them, are extremely arrogant, and thus has an increased sense of entitlement (Pardue et al., 2013). The following scenario with a young psychopath many years ago provides an excellent example of the referenced behavior. This young man stole some money from the wallet of another of his peers. The first author, who happened to be his case counselor at the time, observed this act. When confronted about this act, he flatly denied any admission of guilt. When asked where he then got this large sum of money, he detailed and constructed an elaborate tale involving a rich uncle who left him a trust. His tale went on to describe a large villa in Spain to which he would be retreating to upon his termination from the center where he was being treated.
Due to the fact that psychopaths feel little to no remorse or empathy and have a grandiose perception of self, clinicians can use this to their advantage. They can take the opportunity to praise the cleverness of the behavior (e.g., how psychopaths may have painstakingly planned and executed their actions). This will speak to psychopaths’ sense of superiority, and provide a stage for them to continue preaching and bragging, thus providing more information for assessment purposes.
Passion drives people to go further to explore and learn in order to master a subject. Most people enjoy listening to music. This passion is what drives individuals who are interested in music to explore skills required to play an instrument. Similarly, many people are interested in technology, but only passionate people go on to become engineers. Psychopaths, with the exclusion of successful psychopaths, normally do not penetrate beyond the surface of most knowledge due to their lack of passion for anyone other than themselves. As a result, they exhibit a superficial comprehension of a portion of many subjects, but are often seen by true experts as being shallow. According to Thompson et al. (2014), their superficiality extends to their attempts at acting normal, but exhibiting false emotions by an exaggerated effect. This is an additional key component useful in both identifying and interviewing psychopaths.
Furthermore, psychopaths can be extremely glib and charming, and they are often quite used to being reinforced for their behavior as they tend to draw others in, charming them with their grandiose sense of self. However during the interview, according to Lafarge (2006), if this charm does not work, then psychopaths may become aggressive as they are experiencing what is referred to as a “narcissistic injury.” Moreover, they may become insolent and even hostile. It is important that interviewers remain calm and composed; if not, psychopaths will view this as a sign of weakness and may engage in more predatory behaviors.
Psychopaths are often irresponsible since, from their point of view, nothing is ever their fault. Someone else or the world at large is always to blame for all of their problems. This makes sense if clinicians understand that psychopaths make themselves perfect. Nothing wrong can originate with them, so their logic absolves them of any blame.
During a prison interview with a young man who was being questioned about why he shot the victim seven times in the back, he responded,
I thought he had a weapon. When I fired the first shot, I thought he was going to fire back, so I continued to fire the gun. He caused me to continue firing the gun. Unfortunately, the first shot spun him around, causing the bullets to hit him in the back. If he didn’t look like he had a gun, I wouldn’t have shot him.
As evidenced by this example, psychopaths will often minimize their responsibility, pardoning themselves of any fault or blame. Interviewers can also minimize psychopaths’ responsibility or extent of harm in order to keep them talking. The more psychopaths engage in conversation, the more interviewers can glean about their cognition and potential behavior, adding weight to the assessment portion of the evaluation in addition to being helpful during treatment.
Impulsive behavior makes sense in light of psychopaths’ megalomania. Psychopaths are narcissistic, making decisions based on their own wants and needs and completely disregarding the wants and needs of others (Thompson et al., 2014). In their world, whatever they want now is good. Whatever they do not want now is bad. Thus, if psychopaths want sex and their dates will not provide it, then rape is good and the dates are bad. If people have money is their pockets and psychopaths want it, then robbery is good and the victims are bad. Thompson et al. reported that a very common response from psychopaths is, “I did it because I felt like it” (2014, p. 487). They can act out impulsively to satiate their own need. As stated by Heritage and Benning (2013), overall the impulsive psychopathy factor correlates to poor behavioral performance, predominantly as it relates to response inhibition. It should be noted that recent reports indicate a contrast in impulsivity for successful psychopaths. Thompson et al. reported that successful psychopaths show an increased ability to thwart their impulsive tendencies, often controlling their behavior and thus delaying gratification (2014). Therefore, treating clinicians must bear this in mind, after identifying psychopaths, to determine if they would be considered successful psychopaths, as the impulsive aspect of their behavior may appear normal. One underlying theory relating impulsivity to psychopathy was marked by Heritage and Benning (2013), who reported that psychopaths may be deficient in their behavioral adaptability to changing circumstances, which may be a direct result of their inability to process cues telling them there is a need to change their behavior.
Due to their impulsivity and response inhibition, psychopaths may be easily bored, constantly seeking other stimulation during the interview. There are several strategies interviewers can use to keep psychopaths interested, such as trading out interviewers, changing topics, or letting the psychopaths take the lead, telling the interviewers whatever they choose about their behavior. This may facilitate more expansion from psychopaths, leading to more information.
Quite often in society lying is viewed as a common phenomenon, one that plays a role or serves a purpose in everyday life. However, this phenomenon is exacerbated in psychopaths. Psychopaths are commonly described using the following terms: dissemblers, malingerers, or prevaricators. These are all different labels for versions of a synonymous action, which is deliberately misleading others and getting them to believe false information through words or actions. Lying can also be psychologically compulsive with no apparent reason for it, sometimes referred to as “pathological lying” or “pseudologia fantastica” (PF). According to Birch, Kelln, and Aquino, “pathological lying, as in PF, is quantitatively and qualitatively distinct from normal lying. Quantitatively, it must be excessive and chronic” and can be described as “a veritable orgy of lying. Indeed, lying in PF is so excessive that it often appears impulsive, and to be associated with at least some dyscontrol” (2006, p. 301).
Pathological lying is key element considered by licensed professional counselors in diagnosing psychopathy. Lying, however, is not limited to full-fledged psychopaths as it is observed in the general population through pathological lying, stealing, submitting false expense claims, conning, and manipulative behavior. However, when conducting an interview with these individuals, we must look at the motive for said behaviors. For example, perhaps these individuals are submitting false expense claims because they lack the finances for a severe medical condition, thus deficient of any true malicious intent. It is imperative that we explore each and every data source before making a diagnosis of psychopath to consider the intention and goals.
When more information has been gleaned about their intentions and goals and they have been proven malevolent, then interviewers can simply let psychopaths speak, reminding them to stay on topic. This will culminate in a series of contradictions, ones interviewers can point out well into the evaluation. If psychopaths are contradicted too early, then they may become abrasive or simply attempt to change the topic. Psychopaths will continue to lie until provided hard and fast proof, using their own words, to solidify the contradiction. Even then, they may continue to compulsively lie, but this information still provides ample material to interviewers for evaluation purposes.
In part I of this series we have provided counselors with definitions, a brief overview, and key characteristics of psychopathy. In part II we will clarify the importance of understanding anxiety in psychopaths, provide case studies, and recommend therapeutic treatment options.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Birch, C. D., Kelln, B. R. C., & Aquino, E. P. B. (2006). A review and case report of pseudologia fantastica. The Journal of Forensic Psychiatry & Psychology, 17(2), 299–320.
Brites, J. (2016). The language of psychopaths: A systematic review. Aggression and Violent Behavior, 27, 50–4.
Coid, J., & Yang, M. (2008). The distribution of psychopathy among a household population: Categorical or dimensional? Social Psychiatry and Psychiatric Epidemiology, 43(10), 773–81.
Heritage, A. J., & Benning, S. D. (2013). Impulsivity and response modulation deficits in psychopathy: Evidence from the ERN and N1. Journal of Abnormal Psychology, 122(1), 215–22.
Kauten, R., Barry, C. T., & Leachman, L. (2013). Do perceived social stress and resilience influence the effects of psychopathy-linked narcissism and CU traits on adolescent aggression? Aggressive Behavior, 39(5), 381–90.
Lafarge, L. (2006). The wish for revenge. Psychoanalytic Quarterly, 75(2), 447–75.
Lishner, D. A., Vitacco, M. J., Hong, P. Y., Mosley, J., Miska, K., & Stocks, E. L. (2012). Evaluating the relation between psychopathy and affective empathy: Two preliminary studies. International Journal of Offender Therapy and Comparative Criminology, 56(8), 1161–81.
Ogloff, J. R. P., Campbell, R. E., & Shepherd, S. M. (2016). Disentangling psychopathy from antisocial personality disorder: An Australian analysis. Journal of Forensic Psychology Practice, 16(3), 198–215.
Pardue, A. D., Robinson, M. B., & Arrigo, B. A. (2013). Psychopathy and corporate crime: A preliminary examination, part 1. Journal of Forensic Psychology Practice, 13(2), 116–44.
Thompson, D. F., Ramos, C. L., & Willett, J. K. (2014). Psychopathy: Clinical features, developmental basis, and therapeutic challenges. Journal of Clinical Pharmacy and Therapeutics, 39(5), 485–95.
Stevens, G. W., Deuling, J. K., & Armenakis, A. A. (2012). Successful psychopaths: Are they unethical decision-makers and why? Journal of Business Ethics, 105(2), 139–49.