Psychopathy: what is meant by psychopathic disorder?

By Cristiano Antonino Last updated Jun 20, 2023

Psychopathic Disorder (psychopathy) is characterized by an enduring pattern of antisocial behavior that begins in childhood

It is the first personality disorder historically recognized in psychiatry and boasts a long clinical tradition.

It is characterized by a series of interpersonal, affective and behavioral factors listed below:

Talkativeness / superficial charm: the psychopath is often a funny and pleasant conversationalist, capable of telling unlikely but convincing stories, which put him in a good light in the eyes of others;
Grandiose sense of self: Psychopathy is characterized by a high opinion of one’s own worth and characteristics;
Need for stimuli/propensity to boredom: the psychopath gets bored quickly and tends to seek behavioral or emotional re-activation by assuming risky behaviors;
Pathological lying: usually has a remarkable readiness and ability to lie;
Manipulativeness: he may use fraud to defraud, deceive or manipulate others, in order to achieve a personal purpose perceived as advantageous;
Absence of remorse/guilt: Psychopathy can manifest as a lack of concern for the negative consequences of one’s actions;
Superficial affectivity: emotions are often theatrical, superficial and short-lived;
Behavioral control deficit: the psychopath may be choleric or irritable, as well as respond to frustration with verbally aggressive behavior or violent conduct;
Impulsivity: A lack of reflection, planning, and premeditation may be present in psychopathy.

Neurobiological features of psychopathy

The neurobiological models of psychopathy have focused on the peculiar functioning of the limbic and paralimbic structures, in particular the amygdala and the ventromedial prefrontal cortex, trying to shed light on the association between dysfunctions in these areas and deficiency/lack of empathy and behavior regulation.

There are mainly two theses that have attempted to explain why people with psychopathy do not normally experience empathy and guilt: (a) the empathy deficit hypothesis (Blair 1995) and (b) that of deficient fearfulness (propensity to fear) (Hare 1970; Kochanska 1997; Lykken 1995; Patrick 1994).

According to the “empathic deficit” hypothesis, there would be an anomaly in the functioning of the amygdala which would make it difficult/absent to recognize other people’s emotions such as anxiety and sadness.

The second thesis claims that at the basis of the disorder there is an alteration of the amygdala which would manifest itself in the poor fearfulness (low reactivity to harmful or threatening stimuli).

It would imply insufficient sensitivity to punishments and, consequently, a limited relevance attributed to moral norms.

Emotional characteristics of psychopathy

Psychopaths show difficulty processing emotional information and responding empathically to others.

This deficit could be the basis of the success that these individuals often have in manipulating and deceiving other people, resulting in convincing.

The absence of emotional reciprocity and empathy, or the reduction of intensity with which emotions are experienced and represented, could explain the peculiar ability of persuasion that characterizes these individuals: lacking empathy, in fact, psychopathic people would be more able to represent their victim as “an object to use”, managing not to feel remorse or guilt for the consequences of their actions.

Cognitive features of psychopathy

The psychopaths’ basic schemas of self, others and the world seem to be characterized by rigidity and inflexibility: the psychopath sees himself as strong and autonomous, while others as weak and liable to exploitation (prey).

There is typically a bias in which the malicious intentions of others are overestimated.

The psychopath will therefore tend to pay maximum attention, minimizing the risk of victimization and becoming an aggressor himself.

Scientific literature has explored the capacity for moral judgment in psychopathy, trying to understand whether or not the person affected by this problem is capable of distinguishing “what is right” from “what is morally wrong”.

Research results have highlighted how people suffering from psychopathy mainly exhibit utilitarian personal moral judgments: this would explain the tendency to violate social rules and norms in order to obtain advantages for themselves.

According to this perspective, the psychopath would generally be hyper-concentrated on the goal and, as a consequence, would fail to take due account of the “moral” costs of his own conduct.

Role of empathy in psychopathy

Empathy normally exerts an inhibiting effect on aggressive behavior as it represents a shared affective experience between two human beings.

According to Feshbach and Feshbach (1969), individuals capable of accurately assuming the other’s perspective are more inclined to implement prosocial actions rather than aggressive behaviors.

The difficulty observed in psychopathic subjects in representing and “feeling” the other’s emotional experience has been interpreted by other scholars as the consequence of an active and conscious distraction from the victim’s gaze, which the antisocial person would voluntarily implement in order to inhibit the natural activation of prosocial feelings and therefore being able to maintain a cold and sufficiently detached attitude.

Indeed, the ability to grasp another’s fear or sadness is not necessarily accompanied by a positive attitude: the empathic resonance of the suffering of others can even be at the service of “immoral” desires.

It follows that, rather than having an empathy deficit, psychopaths could have “antisocial goals” and not give so much weight to the representation of the other’s suffering, whether empathic or intellectual, rather than to the representation of their own personal purpose (Mancini, Capo and Colle, 2009).

Evolutionary paths of the psychopathic personality

The developmental history of psychopathic persons is generally characterized by dysfunctional parenting experiences, as described by Patterson et al. (1991; 1998).

According to the “coercion theory” psychopathic behavior is learned within the family and then generalized to other contexts and situations. Children’s uncooperative behaviors would be a consequence of coercive interactions between parents and children.

Some examples of dysfunctional parenting are: inconsistent or, conversely, excessively strict discipline; low supervision and monitoring; insufficient expression of affection; high number of negative verbalizations and high expressed emotionality (Cornah et al. 2003; Portier and Day 2007).

Research by Patterson and colleagues (1991) shows that the parents of subjects with psychopaths rarely exercise a significant and contingent punishment for the aggressive and non-cooperative behavior they intend to reduce, moreover, they do not provide instructions to the child through aversive stimuli.

If they do, this is done on the emotional wave of the moment (angry attitude, exaggeration of the punishment then retracted, inconsistency in managing contingencies, etc.).

Longitudinal studies carried out by Patterson and collaborators (1998) have also shown that the coercive interactions just described between parents and children predict aggressive relationships with peers and affiliation to deviant groups in adolescence.

Implications for the treatment of psychopathy

From the point of view of prognosis and treatment, it has been observed (Robbins, Tipp, Przybeck, 1991) that antisocial and psychopathic tendencies tend to decrease naturally over the years, especially when over forty-fifty years of age (Black, 1999) and that criminal actions or, at least, violent crimes, normally tend to recede.

The behavioral components of psychopathy are usually more likely to benefit from treatment than the personality traits typical of the disorder (Dazzi & Madeddu, 2009).

The ability to feel empathy can be a crucial element for a more favorable prognosis (Streeck-Fisher, 1998) in the treatment of psychopathy.

We have seen how the low sense of guilt of psychopathic subjects and the low propensity to respect social and ethical norms can also be explained as the result of particular evolutionary experiences that have predisposed the subject to the creation and maintenance of specific goals and beliefs such as:

propensity to perceive others as hostile, unfair and rejecting;
experience of authority as unfair and inadequate for the role (excessively controlling or lax and disinterested);
investment in dominance and aversion to heteronomy;
experiences of non-belonging and diversity with respect to the general group of peers.

Evidently, marrying the thesis of the “structural deficit” of psychopathy or that based on goals and beliefs implies numerous differences on the clinical level.

Considering the low sense of guilt as the effect of specific experiences with the authorities and with peers, rather than as the expression of a cognitive deficit, it implies, in fact, the preference to rehabilitation interventions aimed at recovering deficient mental functions (training focused on theory of mind and empathy), specific procedures aimed at:

induce the subject to understand the nature and the reasons for his own behavior through a review of his own evolutionary history;
foster more positive experiences of authority (highlighting, for example, its protective and supervisory function with respect to reciprocal rights and duties);
manage action-reaction contingencies in order to make the consequences of the action certain and predictable both in reference to the “punishments” (certainty of the penalty) and to the deserved “gains”;
reduce hostile attributional bias;
encourage the construction of a social role (attitudes, skills, etc.) useful for fostering belonging and cooperation;
to experience the pleasure and functionality of affiliation and prosociality;
connect personal value and good image with ethical behavior

Essential bibliography

Blair, R., Jones, L., Clark, F. e Smith, M. (1997). The psychopathic individual: a lack of responsiveness to distress cues? Psychophysiology 34, 192–8.

Crittenden, P.M. (1994). Nuove prospettive sull’attaccamento: Teoria e pratica in famiglie ad alto rischio. Guerini, Milano.

Mancini, F. & Gangemi, A. (2006). The role of responsibility and fear of guilt in hypothesis-testing. Journal of Behavior Therapy and Experimental Psychiatry 37 (4), 333-346.

Moffitt, T.E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review 100, 4, 674-70.

Patterson, G.R., Capaldi, D. & Bank, L. (1991). An early starter model of predicting delinquency. In DJ Pepler e kH Rubin (Eds), The development and treatment of childhood aggression. Erlbaum, New York.