Psychopathy

Following are some of the signs and symptoms of psychopathy: 

• Some patients have excessively manipulative and selfish personalities with no care for others while others may present with repeated crimes and violent acts. 
• As per studies conducted, psychopathy is associated with antisocial acts along with crime and violence. The scoring as per the aforementioned triarchic model shows higher values in patients with repetitive imprisonments, drug abuse and those who are detained in high-security detention centres. (Read more: Drug addiction)
• Research suggests a strong association between scoring for psychopathy and violence. Psychopathy itself is not synonymous with violence but psychopathic patients have often been described as predatory or having “cold-blooded” aggression, which is defined by low emotions. Data show that the number of homicides caused by psychopathic offenders are way higher than those by non psychopathic offenders. Nearly 30% of those who perpetrate domestic violence are found to be psychopaths. The features of psychopathy such as lack of remorse and inability to form close bonds increase the chaces of psychopaths perpetrating domestic abuse. 
• Psychopathy has also been linked to sexual crime as patients exhibit signs of violent sexual behaviour. As per studies published, sexual crimes and child molestation are significantly associated with psychopathic behaviour. (Read more: Sexual health)
• Organised crime, war crimes and terrorism have often been linked with psychopathic behaviour. 
• They may have a grandiose sense of self-worth and charming personalities. 
• They are usually pathological liars and highly prone to boredom. 
• They may have a need for stimulation and a shallow or decreased emotional response. 
• They are known to have parasitic lifestyles and many patients exhibit behavioural problems early on in their life. 
• Patients do not have any long term targets 
• Patients usually have short marriages ending in divorces 
• Family members describe the patient’s behaviour as irresponsible 
• Patients commit a wide variety of crimes i.e. criminally versatile. 

(Read more: Sexual anorexia)

Genetic research has been able to identify numerous genetic and non-genetic factors that may influence the functioning of the brain. Scientists have concluded that psychopathy is a result of an interaction between genetic factors and adverse social settings. 

• Genetics: Studies conducted show that patients with psychopathic traits have moderate genetic influences. It has been concluded that the development of psychopathy is based on genetic factors whereas the expression of traits exhibited is dependent on the environmental conditions around the patients. 
• Environment: Environmental factors that lead to the development of psychopathic behaviour include the following : 
  • Having a parent with a history of crime 
  • Being physically neglected as a child 
  • Having poor relations with their father 
  • Born into families with low income and poor socio-economic status 
  • Disrupted broken families 
  • Poor parental supervision
  • Experiencing harsh methods of discipline 
  • A larger family size 
  • Having siblings with criminal records 
  • Having mothers who are young or depressed
• Brain injuries: Research suggests an association between head injuries and psychopathic traits like violence and committing crimes. An injury to the prefrontal cortex of the brain may result in psychopathy and an inability to make moral decisions. This condition is termed as acquired or pseudo psychopathy. These patients show significantly similar behaviour to known psychopathic patients. The traits may be more severe in the case of brain injuries in young people. Some patients may not develop social reasoning and develop extreme aggression along with antisocial behaviour with no remorse or empathy for people who they inflict crimes on.

There are numerous tools and methods to diagnose psychopathy. They are as follows: 

• Psychopathy checklist, revised (PCL-R): This is the most common method of assessment of diagnosing psychopathy. It is based on Cleckley’s criteria. It is considered to be the gold standard method to assess psychopathic traits. 
• Psychopathic personality inventory: This has been developed to index some personality traits instead of referring to antisocial traits or criminal acts. It comprises nearly 154 points and is known as the PPI-R (revised in 2005). It includes factors like fearlessness, impulsivity and coldheartedness. 
• Diagnostic and statistical manual of mental disorders (DSM): The DSM is a tool to classify mental diseases established by the American Psychiatric Association. As psychopathy isn’t recognized in it yet, the closest condition, antisocial personality disorder, can be diagnosed with its help.
• International classification of diseases: Also established by the American Psychiatric Association, it is also a widely used tool to classify mental diseases. Other tools include the following : 
  • Minnesota multiphasic personality inventory
  • California psychological inventory 
  • Millon clinical multiaxial inventory 
  • Antisocial personality disorder scale 
  • Levenson self-report psychopathy scale 
  • Hare self-report psychopathy scale 

Psychopathy may present with a large number of psychiatric illnesses. They may include the following: 

• Antisocial personality disorder 
• Histrionic personality disorder 
• Narcissistic personality disorder 
• Borderline personality disorder 
• Paranoid personality disorder 
• Schizoid personality disorder
• Panic disorder 
• Obsessive-compulsive disorder 
• Schizophrenia 
• Depression
• Attention deficit hyperactivity disorder 

(Read more: Personality disorders)

Psychopathy is a highly refractory personality disorder that is considered extremely difficult to treat. Patients usually do not wish to seek treatment for this illness and are very uncooperative if treatment is started. 

As of now, there are no known pharmacological therapies that can help with the lack of emotions and poor social relationships associated with psychopathy. Some patients who receive psychotherapy may pick up methods and skills to manipulate and deceive others and hence, are more likely to commit a crime.

Punishment along with behaviour modification is usually considered ineffective in these patients as they are considered to be insensitive to punishment and threats. 

The antisocial and criminal behaviour is considered to be amenable to treatment with the therapy usually provided in correction centres. These treatments aim to concentrate on self-interest, social acts and interventions that help patients gain skills that help them in achieving their own life goals through prosocial methods instead of antisocial techniques. 

In correctional institutions, psychopaths are offered a reward-based management system that allows them to be given small benefits in exchange for decent behaviour. 

Medications that are commonly used in psychiatric patients help in improving other mental illnesses that occur in psychopathic patients or patients with excessive impulsiveness and aggression. 

These medications include antipsychotics, antidepressants and mood stabilizers. It is important to note that medications have not been approved by the FDA for the treatment of psychopathy. An antipsychotic drug called clozapine has shown to reduce impaired behaviours in hospital patients with psychopathy and antisocial personality disorder. 

Patients with psychopathy are considered to have a very poor prognosis in the forensic and clinical scenarios. Some data suggest that treatment can actually make the antisocial features in psychopaths worse. Some modern treatments that are available nowadays have shown reduction in future violence and crimes in psychopathic patients regardless of their PCL-R scores. There is also evidence of a reduction in the prevalence of substance abuse in patients who receive modern psychiatric treatment. 

Psychopathy can be classified as: 

• Primary psychopathy: It presents with low anxiety and is usually caused by genetic factors.
• Secondary psychopathy: Secondary psychopaths are usually extremely anxious and have unstable emotions which are linked to environmental causes like neglect and mistreatment.

Often, the terms psychopath and sociopath are used interchangeably. A sociopath is an individual with antisocial traits that are based on social and environmental characteristics only whereas psychopathic clinical features are considered to be mostly innate. 

Antisocial personality disorder often overlaps with the term psychopathy but it is important to know that the two conditions are different. A patient can be termed as having an antisocial personality based on the criteria available that focuses on antisocial behaviour and may not have any other features suggestive of psychopathy. Only a small number of people with antisocial personality disorder are considered to be psychopaths. 

The PCL-R is a commonly used method for assessment of risk and treatment potential in criminal courts for psychopathic patients. It is also used to formulate decisions for the bail, sentencing, parole settings, which detention centre to send the patient to and if a young individual should be tried as an adult or a juvenile. Studies show that the PCL-R is highly reliable and should be used carefully. 

To help with criminal cases, various interrogation approaches are often used to exploit and use the personality traits of psychopathic patients to try to make them disclose more information that may be relevant to the case.

It is more common for males to be psychopaths as compared to females. Females psychopaths can be different in terms of certain clinical traits; for example, they are less likely to be physically violent. But, they are considered to have higher anxiety levels and issues with their self-image and confidence.