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  • Writer's pictureJ. Sutton

Understanding Psychopathy

Updated: Mar 10

Criminal Behaviours explores Psychopathy -

The theories, The studies, and how its applied to crime.

The word Psychopath is used in everyday society to describe a person who displays vile or explosive anti-social behaviours, it is a term used very loosely in everyday language as a common insult, and a character depicted in many famous Thriller and Horror movies as the person you least expect, smart, cunning but crazy who often seems to get the better of their victims and the police.

But how much of this is true? who are psychopaths? are they really all crazed killers? and why do we only seem to hear about them when it comes to crime.

Its not as simple as it first seems there are many complexities regarding psychopathy, its not a diagnosis Doctors will give lightly due to the implications of the disorder itself and it will take a fair amount of time to get a diagnosis. The tests required to measure it accurately are intricate and thorough.

There are different types of psychopath the one we hear the most about is the criminal psychopath and the one you won't hear so much about is the 'successful psychopath'.

These two groups differ in the fact that a 'successful psychopath' is usually doing well in life, doesn't get in trouble with the law, generally have positions of authority in the workplace, charming, well turned out, and articulate.

However just as the criminal psychopath they are also callous, self-serving, lack empathy and are manipulative. Studies have shown they will bully in the workplace, take credit for work they haven't done, and have no problem stepping on other peoples toes to get the position they want.

They also crave and need control so often seek out roles in society that come with power for example a company CEO or a Lawyer. You can find them in political roles throughout society too, again taking on a place in society that gives power and some form of respect, where they are seen as an important authoritative figure playing into their ideas of grandiose.

The study into 'successful psychopathy' is in its infancy due to the fact that the majority of information we have on this disorder has been gathered using only those involved with criminality, so we are only just beginning to understand the different ways some one with psychopathy can inter-grate within society.

This demonstrates that not all psychopaths are serial killers or mass murderers, and can actually contribute to society in more productive ways.

This also means that unlike in the past a comparative has been identified, it is now understood that people who have psychopathy can actually be functioning members within society. It also has the potential to tell us why some psychopaths go on to be violent criminals while others go on to be frugal business people.

Psychopathy is linked to a group of disorders known as Cluster B personality types these are,

  • antisocial personality disorder.

  • borderline personality disorder.

  • histrionic personality disorder.

  • narcissistic personality disorder.

Psychopathy isn't an independent condition or disorder as such, you don't necessarily get solely diagnosed as a Psychopath but more as someone who has traits of psychopathy. The rate or frequency in which those traits impact a person being able to function within the norms of society will determine if they are indeed a psychopath.

Those traits could interlink with another personality disorder (cluster B) that can be diagnosed, so that person would have for example Anti-Social Personality Disorder (ASPD) with psychopathic traits or aspects within that main disorder. The degree and frequency also varies someone with only a few traits overall would not qualify as psychopathic, whereas a person with at least 3/4 traits within various areas of their life such as social or emotional functioning would be classified as a psychopath.

This is why you see many psychopathic characteristics interlinking with the main Cluster B type disorders, but yet not being classified as psychopathic. This will be explained in more depth further on.

The difference between being psychotic and psychopathic.

The term 'psycho' is often used interchangeably by the general population to mean either psychotic or psychopathic but in clinical terms these are two very different things.

The term 'psycho' would be in relation to a person suffering with a form of psychosis and it is short for psychotic.

The main difference between the two is that someone who is suffering with a psychotic disorder "is out of touch with reality. He or she cannot distinguish between what is going on in the outside world and what is going on in their heads. Theoretically, in a legal sense psychotic individuals should not be held accountable for their actions. Medically, they are mentally ill and suffering from a brain disorder" - Haycock. D (2014)

Their thoughts are usually disorganised & paranoid, they will show signs of incoherent speech, and seem as though they are not fully aware of their surroundings when spoken too. An example of someone who is psychotic would be someone who suffers with schizophrenia.

In contrast to this a psychopathic person knows exactly what they are doing, and they will know it's wrong, and will fully recall their actions after the fact, but won't care how those actions affected others. They will only be interested in reaching their goal, for their reasons, remorse and regret are not something that impacts a psychopaths decision making.

Many psychopaths get pleasure from committing their crimes, but someone suffering psychosis wouldn't necessarily get pleasure from it. It would be a means to an end they would be disoriented and possibly frightened or severely paranoid acting in a fight or flight response due to their perceived reality. This is a mixture of actual events, paranoia and visual or audio hallucinations, they also have distorted recollection of events and at times are unable to even recall what they have done during an episode of psychosis.

Much unlike the cool collected psychopath, who will have premeditated their actions, plotted and planned their crime and will be thoroughly enjoying committing it and would have total recall of events and reasons for their actions after the fact.

The difference between being a Sociopath vs a Psychopath

Another area that is often misunderstood or confused is how a sociopath differs from a psychopath. Many people argue they are one in the same, however when you look at the criteria of each and compare them there are significant differences, this is where the confusion comes from.

Sociopathy in essence is not a disorder, in other words you cannot be diagnosed as a sociopath. Its not recognised as a disorder in itself, rather a set of social behaviours that link in with other disorders such as psychopathy or mainly ASPD.

The different factors also account for different measures of behaviour in different regards.

Factor one focuses mainly on interpersonal behaviour, linking in with social associations, connections, or affiliations between two or more people and the individuals perceptions of those interactions. Those with factor 1 tend to be more self controlled emotionally and less reactive to social situations.

Factor two differs somewhat and focuses more on the social aspects and impacts of the behaviour as well as the persons emotional reactivity. Those who fit into this category tend to be very impulsive, and emotionally reactive, they will get bored easily and seek out stimulation. Unlike someone with factor one they are more emotional so can be compassionate and remorseful.

This can be understood more clearly when you look at the 2 factors of psychopathy and what traits the person would have to have in order to be deemed as one or the other.

  1. Factor 1 - primary Psychopathy - Callous, unemotional, pathological lying, manipulative, fearless - lacks sense of danger or risk, need for dominance/control, lacking in remorse, low neuroticism (emotionally stable).

  2. Factor 2 - secondary Psychopathy - impulsive, high neuroticism (emotionally unstable) sensation seeking, involving them-self in criminal behaviour - strong relationship with ASPD

From this you can gain a basic understanding of how the two are similar but also different, it is thought by some professionals that sociopathy is an extended subset of Anti-social personality disorder rather than a disorder in itself.

It should not be classified in such a way that would suggest it is an independent disorder but instead another extremity of ASPD.

Because of this the term sociopathy/sociopathic are no longer endorsed or recognised by organisations such as The American Psychological Association.

Conduct Disorder and Anti-Social Personality Disorder

In order to understand what Psychopathy is and isn't you need to understand the difference between Psychopathy and Anti-social personality disorder (ASPD/APD).

Although they are disorders that interlink via subsets they are not the same thing, a diagnosis of one does not mean that both are present, in many cases those who have ASPD are not psychopaths.

Anti - social personality disorder (ASPD/APD) can only be diagnosed once a person is 18 or older.

In order to get a diagnosis they would need to have have 3 or more of the diagnostic traits and historically would of been diagnosed with Conduct disorder during their early teens age 15 or younger.

The symptoms of Anti-social personality disorder cannot occur exclusively during the course of Schizophrenia or Bipolar disorder to be diagnosed as such (they cannot co-exist only in episodes of psychosis).

In other words the person would need to have symptoms of ASPD present even when they are not having episodes of psychosis related to Schizophrenia or Bi-Polar (assuming they suffer either of these.) This is due to both Schizophrenia and Bi-polar disorder sharing trait similarities with ASPD, observing ASPD traits continually in behaviour avoids misdiagnosis and incorrect treatment of the specific disorder.

Almost all Psychopaths would qualify for ASPD however not all those who have Anti-social personality disorder would qualify as Psychopaths.

For example, around 70 - 80 % of the American prison population (Male) would qualify as having anti - social personality disorder but only 15 - 25% of those would qualify as having a form of Psychopathy.

As mentioned above in order to be diagnosed with ASPD a person would need a diagnosis of conduct disorder before they reach the age of 15, and can only be given a diagnosis of ASPD once you are 18 or older.

This is not the case for a diagnosis of Psychopathy there is no rule regarding age. But with that said a diagnosis of psychopathy before the age of 18 is very rare and usually only given under extreme or unusual circumstances. The person would also not need a diagnosis of Conduct disorder to be given a diagnosis of psychopathy.

Another difference with Psychopathy is that a person suffering with Schizophrenia or Bipolar disorder can also be suffering symptoms of psychopathy during psychosis, meaning symptoms of both can co-exist and be present at the same time.

So with some similarities between the two disorders what makes Psychopaths different to those who only suffer with ASPD. To understand this a comparison of how they are both measured is necessary.

The Diagnostic criteria for ASPD

A diagnosis of Anti-Social Personality Disorder will be given to a person who has displayed consistent deviant and dangerous behaviours throughout their childhood and young adult life. Behaviours such as theft, assault, rule breaking, absconding and a disregard for others safety or well-being.

These behaviours would be on record from a young age, the behaviours will be documented as occurring frequently and in all situations i.e. Home life, school life, social life.

Generally before the child reaches the age of 15 they will of been assessed and diagnosed with conduct disorder. During this assessment the severity of their behaviours will be indicated based on a scale of mild, moderate or severe.

Once that person turns 18 they will be reassessed to see if they have ASPD, if for whatever reason the persons behaviour has subsided and they are functioning within the norms of society again they will have only a historic diagnosis of Conduct disorder and would not receive a diagnosis of ASPD.

However in the case that a person had moderate conduct disorder as a child and does not fit the criteria for ASPD but is also not functioning within the norms of society (still offending/ rule breaking) then they would have a fixed diagnosis of Conduct disorder rather then ASPD.

A person with ASPD would already have a historic diagnosis of Conduct disorder with evidence, as well as having 3 or more of the 7 traits below.

They must fill this criteria in order to qualify for ASPD

Violation of social norms



Irritability and aggression

Disregard for safety


Lack of remorse

The Diagnostic criteria for Psychopathy

On the whole this is measured differently to ASPD it looks at different areas of the personality, and the behaviours linked to the personality

It can be measured in two ways using a 4 factor model this is the most common (PCL-R HARE psychopathy checklist) or using self report tests. Due to the variation in the results of each type of test both versions of testing are sometimes used as a multi-method assessment which can give a more accurate diagnosis.

With The Hare Psychopathy Checklist-Revised (PCL-R) a person must score above 30 to be deemed a psychopath. This is not easy to reach and many lifetime offenders will not come anywhere near the score needed to be deemed as psychopathic despite living a life of crime.

For example Ted Bundy scored a 39, Serial killer Aileen Wuornos received a score of 32, a non-psychopathic criminal scores on average about 22, a normal law abiding citizen would score around 5.

How is the PCL-R scored?

The HARE checklist is a psychometric test to measure 4 facets of an individual.

These are Interpersonal; Affective; Lifestyle and Anti-social.

Within these are sub criteria that must be met in order to qualify as a psychopath.

Below are examples of some of the criteria to be met within each subset, this is not the full list only a partial one to give some indication of the types of behaviours that are assessed.


  • Pathological Lying

  • Superficial charm - Affective Mimicry

  • Manipulative

  • Grandiosity


  • Lack of remorse

  • Doesn't accept responsibility

  • Callousness

  • Shallow Effect


  • Impulsivity

  • Irresponsibility

  • Lack of realistic goals

  • Parasitic living habits

  • Need for consistent stimulation

Anti - Social

  • Early behavioural problems

  • Juvenile delinquency

  • Poor behaviour management (Lacks social boundaries)

The checklist can be completed a couple of ways, but cannot be scored based solely on an interview, supporting documentation and detailed historical evidence must be supplied to accompany the evidence from the interview.

"The PCL–R is completed on the basis of a semi-structured interview of 90 to 120 mins duration. The PCL-R can be scored on the basis of file information alone, provided that the material contained in the files is extensive and detailed. . . It is important to note, that the PCL-R cannot be scored on the basis of an interview alone" - Hare (1998).

Psychopathy, the media and the issues

Over time the general public's perception of things such as psychopathy, psychosis, and Cluster B personalities such as Narcissism for example have be severely distorted and misunderstood.

This is mainly down to people such as journalists or column writers of fashion based magazines who will briefly research the topic (and I really mean briefly) and write about it without any medical reference, or any real understanding of the complexities of such disorders, or the processes of diagnosis and the real life negative implications that it has on people who are labelled with it.

"Diagnosing someone as a psychopath using the full PCL-R requires more than a pencil (or a computer) and a list of 20 items. (Some writers like Jon Ronson, the authour of The Psychopath Test, journalists, and bloggers oversimplify the process of identifying a Psychopath to a misleading degree when they lightheartedly, and at times without a clue, do exactly this and with far fewer than 20 items.) Competent, qualified professionals are trained to administer the PCL-R interview and taught to observe the subject. " Haycock, D. PhD (2014)

This has a knock on effect where the readers now think they are equipped with the knowledge to label friends, family, or romantic partners with disorders such as narcissism or psychopathy. This is very dangerous and also dismissive of the decades of research and training done by those within medical and psychological fields. Often these articles do more harm than good as they try to simplify something that is never simple.

Many researchers and psychiatrists encourage those to refrain from taking such articles and publications seriously, and ask those with concerns for loved ones to seek the appropriate resources to manage their concerns in a way that is safe for both themselves and the person they suspect to be suffering, rather than to rely on information they were given from an Instagram post, self help book or magazine for example.

Psychopathy and gender

Psychopathy statistics would indicate that more men suffer with the disorder than women, but not too much is known about female psychopathy, therefore it may be over or under diagnosed.

It is an area that is gaining momentum in study, and some of the findings suggest that women don't always have the same degree of severity in the criteria as males do. So don't score as high on the PCL-R test.

For example we know that males suffering with factor 1 psychopathy do not regulate their emotions in the same way as a normal functioning person would. They come across as unemotional and have a hard time connecting thoughts and actions with emotions.

"Psychopathic men also failed to show the standard facilitation when responding to emotional words in a lexical decision task (Lorenz & Newman, 2002; Williamson, Harpur, & Hare, 1991), as well as the standard increase in recall for the details of an emotional stimulus (e.g., Christianson et al., 1996)." - Sutton, SK. et al (2002)

There have been a few very well known cases of male psychopaths who are able to use Affective mimicry to temporarily appear as though they have compassion or remorse but not all. It is also temporary it's used superficially as a tool for personal gain rather than it being a genuine emotion.

It seems that women are far more effective at this skill which could be a demonstration that their emotional processing is not as delayed as their male counterparts.

"Recent research has shown that the personality and behavioral characteristics of female offenders categorized as psychopathic using the PCL–R (Hare, 1991) resemble those of psychopathic men (for a review, see Vitale & Newman, 2001b). However, it appears that other aspects of the syndrome observed in men may not be present in women." - Sutton, SK. et al (2002)

Due to having this gender comparison it is now thought that psychopaths do recognise and feel emotions to some degree, studies into emotional regulation and that the way their mind connects situations to emotions is either delayed or faulty resulting in a lack of remorse or guilt and low eroticism.

"These and other laboratory data strongly support the clinical observation that one key component of psychopathy in men and women is abnormal emotion processing, especially in response to unpleasant or threatening stimuli. The implications for such a fundamental deficit are profound. Further investigation should aim to clarify the processes underlying psychopathic individuals" - Sutton, SK. et al (2002)

Women also seem to have different patterns of behaviours historically to males, they don't seem to display anti social traits or traits of conduct disorder until later in adolescence. The types of crimes they commit also seem to differ, while males have higher rates of sexual and violent offending women have higher rates of manipulative or fraudulent behaviours and offending.

Women with psychopathy will use manipulation as a tool to a greater degree in comparison to males, for example the female psychopath will often verbally and emotionally coerce others into doing their dirty work for them. They like to take a more hands off approach and use the trust of others to their benefit.

Socially these women will use their status to isolate others through verbal and psychological tactics things such as spreading rumours to discredit a person, or manipulating others into bullying them until the person becomes easy to abuse and control.

In this regard you can see how the female is more aware of her emotions and how to use them to control others in comparison to a man who will rely on many of his physical attributes such as size and strength to control and over power others.

Psychopathy and childhood

In many instances you will hear of people who are classed as psychopaths as having traumatic childhoods, ones filled with mistreatment, neglect and in a high number of cases violence and sexual abuse. Along with poverty being a reoccurring factor in many case studies too.

This, more often than not is a contributing factor to a child's emotional, physical and psychological development and well-being. What we currently know of childhood development is that prolonged trauma and stress can negatively affect the way a child grows in regards to their emotional processing, moral reasoning, intelligence and psychological well-being.

In most instances this mixture of poverty, abuse and neglect is something we see repeated in lots of offenders past.

It seems that a mix of specific social, emotional, and biological factors contribute to the likelihood of a person becoming psychopathic and when these are combined in a specific order it can be an indicator as to the likelihood of that person being a violent psychopathic predator.

Those who go on to become psychopaths generally have a mixture of all of the things mentioned above. Studies have shown that early intervention can help to alleviate these problems and can reduce the likelihood of the child becoming an offender in the future.

But if left too late (until adolescence) then the likelihood of the child leading a normal life is significantly reduced.

It has also been identified that sexual abuse specifically can impact the likelihood of a child getting symptoms of conduct disorder later down the line.

"the current study confirms that individuals with ASPD and individuals with psychopathy evince extensive abuse histories. We found that this relationship was strongest between physical abuse and the antisocial features of psychopathy. Furthermore, it appears that sexual abuse has a unique relationship with CD symptomology. The study data also indicate that the relationship between childhood maltreatment and the juvenile antisocial features of psychopathy is stronger than the relationship between childhood maltreatment and the adult manifestation of psychopathy." - Dargis, M. et al (2016)

However that said this does not definitively mean that a child raised in these circumstances will definitely go on to have psychopathy or ASPD and be violent criminals, it is merely an indicator of the likelihood that they might steer towards certain behaviours such as criminality.

Psychopathy and intelligence

Early on in the study of psychopathy it was believed that in order to be a psychopath you had to have a high IQ. However more recently this theory has been dis-proven and actually studies are showing that there is much variation in intelligence along with variation in the type of intelligence e.g. emotional intelligence, Logical intelligence etc.

Studies such as Psychopathy and Intelligence: a second look carried out by Peter Johansson (et al. 2005) showed that in fact high IQ does not correlate with psychopathy and suggested it was the opposite in many cases.

"The results showed that for non psychopaths, higher total IQ and particularly verbal intelligence meant a later start in violent crime. For those diagnosed as psychopaths, however, this association was reversed"

Much more study is needed into this area as intelligence has many levels and types, measuring it and recording it can be quite challenging as the studies need to be replicated. Intelligence is also tested in a variety of ways that include both qualitative and quantitative data which then has to be compared. This is very time consuming and often studies will be carried out over a period of years sometimes even decades before the findings can be verified and published. This means progression in areas like this are slow and steady.

Another limitation to this area is that much of the research that has been done has focused only on samples of those involved with crime. Studies into successful psychopathy and intelligence are only just starting to progress, so we are only just starting to understand how non offending psychopaths function in regard to intelligence and its application to their everyday life.

Due to the sample limitations of the current available information discussed above the things we now know about psychopathy and intelligence can often only be applied to prison and criminal populations rather than those of the general public who may have successful psychopathy.

Psychopathy and Biology

As discussed previously someone who is deemed a psychopath is aware of their actions, they are aware they are offending or acting in a less desirable way socially, but they just don't care. In this regard they differ to someone suffering with psychosis who is unable to separate their psychosis from reality.

But this doesn't mean that biologically a psychopath is the same as someone deemed as non psychopathic or someone deemed as biologically normal.

In recent years as psychiatrists and criminologists have had advances in technology they have been able to identify the possible biological indicators for those prone to violence and disorder such as psychopathy, using things such as PET scans of various brain activity and by identifying how under development of specific parts of the brain can contribute or cause behaviours such as bad judgement or impair moral reasoning, which can lead to bad decision making and impulsive behaviours.

This lack of development in areas of the brain such as the frontal lobe for example can impact things such as the concept of danger, meaning a person would be more likely to have risk taking behaviours that puts themselves or others at risk for instance.

In a sense the brain is desensitised (less responsive) to things that a fully developed brain would react too. Meaning in some aspects a person suffering with psychopathy doesn't always have the literal capacity to identify with things such as emotion.

It is suspected that this is due to a fault somewhere in the brain that affects the effectiveness of communication between the Limbic system and the ventromedial prefrontal cortices.

The Limbic system is the most primitive part of our brain and connects to our hypothalamus together they are responsible for the autonomic nervous system and the orbital and ventromedial prefrontal cortices are situated in our frontal lobe they are responsible for reasoning and decision making among other things.

These are the parts of the brain that regulate emotion (the limbic system) and reasoning/morality (prefrontal cortex) making the need for their effective interaction vital to a person in order for them to be able to function as what is deemed as normal.

" your conscience is predicted on the good functioning of your autonomic nervous system, a part of the body sometimes referred to as the "visceral" nervous system due to its key role in emotion. The most important breakthrough in our understanding of this region of the anatomy of violence is that the nervous system of some offenders is simply not as "nervous" as the rest of ours. It confers on them a fearless, risk-taking, conscience-free personality that can result in violent and even psychopathic behaviour" - Raine, A. (2013)

Overall understanding Psychopathy is not an easy task, there are many factors to consider and many other things to rule out. It is an area of study that requires much more attention and examination before we can fully understand all of its implications on the individuals that suffer with it.

From what we do know a psychopath cannot be rehabilitated, it is something they have to live with their whole life and learn to manage in healthy ways, this can be done with the support of family, friends and clinicians such as psychiatrists.

I hope this article has helped you to understand the complexities of this disorder and how it has been studied, and what is being done to learn more about it so that we can better treat those who suffer from it.

Further Reading

Did you enjoy this article?

Then you will also like The Pocket Guide to Psychopathy!

A short book that breaks down what psychopathy is, and isn't. It covers the various implications of the disorder, its clinical history and its application in modern day.

The book looks in depth at how a person may end up with the disorder and diagnosis. With chapters discussing the types of psychopathy and its implications on those that have the traits.

The misconceptions of the disorder are explained and the different ways that psychopathy can present itself in a persons behaviour are elaborated on in detail. There is a section that interviews those with the disorder, their families, and friends to give the reader an insight on what it is like for those with psychopathy, and for those who live and socialise with them.

Click here to get your copy today


Online Links

McCuish, E. (2016). Bringing psychopathy into research on offending trajectories: Understanding the construct's role as a barrier to desistance. -

Carabellese, F. Felthous, A. et al. (2019). Female psychopathy: A descriptive national study of socially dangerous female NGRI offenders. International Journal of Law and Psychiatry. Vol 68, January–February 2020, 101455

Sutton, SK. Vitale, JE. Newman, JP. (2002) Emotion Among Women With Psychopathy During Picture Perception. Journal of Abnormal Psychology. American Psychological Association, Inc. 2002, Vol. 111, No. 4, 610–619 -

Dargis, M. et al (2016) Clarifying the link between childhood abuse history and psychopathic traits in adult criminal offenders. Personal Disord. 2016 Jul; 7(3): 221–228. Published online 2015 Sep 21.doi: 10.1037/per0000147

Bierer LM, Yehuda R, Schmeidler J, et al. Abuse and neglect in childhood: relationship to personality disorder diagnoses.CNS Spectr. 2003;8(10):737‐754. doi:10.1017/s1092852900019118


Hare, R.D., & McPherson, L.M. (1984a). Violent and aggressive behavior by criminal psychopaths. International Journal of Law & Psychiatry, 7, 35-50.

Hare, R. D. (1980). A research scale for the assessment of psychopathy in criminal populations. Personality and Individual Differences, 1,111–119.

Harpur, T.J., Hare, R.D., & Hakstian, R., (1989). Two-factor conceptualization of psychopathy: Construct validity and assessment implications. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1 (1), 6-17.

Haycock, D. PhD (2014)Murderous Minds. Exploring the Criminal Psychopathic Brain: Neurological Imaging and the Manifestation of Evil. Pegasus Books Ltd

Johansson, P. et al (2005) Psychopath and Intelligence: A Second Look. Comparative study. -

Raine, A. (2013). The Anatomy Of Violence. The Biological Roots Of Crime. The Penguin Group. Penguin Books Ltd.

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