What is a Psychopath?: Diagnostic Controversy
It is important when considering this question to understand that there is a controversy. On the one side, there is the traditional description of psychopathy derived from the above mentioned European tradition discussed by Lobaczewski, combined with the older North American Tradition of Hervey Cleckley, Robert Hare and others. This is in general agreement with the experiences of practicing psychiatrists, psychologists, criminal justice personnel, experimental psychopathologists, and even members of the lay public who have had personal encounters with psychopathy.
On the other side of the issue, is what is called a "neo-Kraepelinian" (Emil Kraepelin) movement in psychodiagnosis which is closely associated with research coming out of Washington University in St. Louis, Missouri. This latter view is most closely aligned with the diagnostic criteria of the DSM-III, DSM-III-R, and DSM-IV for Antisocial Personality Disorder. The fundamental approach of this school is that assessment of a psychopath rests almost entirely on publicly observable or known behaviors. The assumption is that a clinician is incapable of reliably assessing interpersonal or affective characteristics. Another assumption is that early onset delinquency is a cardinal symptom of ASPD. This tends to put heavy emphasis on delinquent and antisocial behavior, i.e., publicly observable behaviors that may have no bearing on the internal make-up of the individual.
The criteria of the DSM-III for ASPD was decided by a committee of the American Psychiatric Association's DSM-III Task Force and was revised only slightly by another committee for the DSM_III-R. The DSM-IV criteria were also decided by committee, with little regard for empirical research. [22]. These criteria are less behaviorally focused and thus, somewhat resemble the criteria for other DSM-IV personality disorders.
According to Robert Hare et al, Cleckley, Łobaczewski, and many other experts in psychopathy, a diagnosis of psychopathy cannot be made on the basis of visible behavioral symptoms to the exclusion of interpersonal and affective symptoms because such a procedure essentially makes psychopaths of many people who are simply injured by life or society and allows the true psychopaths who have a well-constructed "mask of sanity" to escape detection. Based on a growing body of literature, many (or most) psychopaths grow up in stable, well-to-do families, and become white collar criminals who, because of money and position, never have their private destructive behaviors exposed to public view and repeatedly avoid contact with the justice system. [23]
The widely publicized work of Robert Hare and Paul Babiak in their book Snakes in Suits demonstrates that psychopathy should be assessed using expert observer ratings based on a clinical interview, compared against a review of case history materials including any criminal or psychiatric records, interviews with family, friends, co-workers, employers and employees, supplemented with behavioral observations whenever possible.
The DSM-IV criteria do not constitute a scale or test. The assessor determines if each criterion is present/true or absent/false. The final decision is: if the criteria are all present, then a lifetime diagnosis of ASPD is made; if one or more is absent, no such diagnosis is made. It can be observed that many psychopaths would easily evade detection via this system and many individuals who are possibly suffering from abuse or terrorization would be classified as ASPD.
Because of the problems with the DSM-III and DSM-III-R diagnosis of ASPD, the American Psychiatric Association carried out a muti-site trial to gather data in preparation for DSM-IV. [24] The field trial was designed to determine if personality traits could be included in the criteria for ASPD (which relies only on publicly viewable behavior), without reducing reliability. The intention of those clinicians who lobbied for this was to bring ASPD back into line with clinical tradition and to end the confusion between ASPD and Psychopathy.
The results of the field trials demonstrated that most of the personality traits that reflect the symptoms of psychopathy were as reliable as the behavior specific DSM-III-R items, thus invalidating the original premise for excluding personality from the diagnosis of ASPD/psychopathy. [25] In other words, including the PCL-R Factor 1 items in the criteria would have improved the validity of ASPD without sacrificing reliability. IRT analyses [26] show that Hare's PCL-R actually measures the latent trait of psychopathy across its entire range! Similar analyses of the field trial data show that the ASPD criteria was less discriminating of the psychopathy trait, particularly at high levels of the trait! In other words, the ASPD criteria set up by the DSM-III-R was designed - intentionally or not - to exclude the most psychopathic psychopaths!
Despite the fact that, after this study, there was an empirical basis for increasing the content-related criteria of ASPD in DSM-IV, this did not happen. It was argued by the DSM-IV committee that the average clinician would not use the carefully structured approach to the assessment of personality traits used in the field trial.
Surprisingly, the criteria adopted for DSM-IV were not even evaluated in the field trial. What was evaluated was the 10-item set of adult symptoms (Criterion C) for ASPD listed in DSM-III-R. The seven-item set now listed in DSM-IV was derived from the 10-item set. More than that, the field trial did not include evaluations of Criterion B (conduct disorder before age 15), a criterion listed in DSM-IV as a necessary condition for a diagnosis of ASPD!
The DSM-IV text description of ASPD (which it says is "also known as psychopathy") contains references to traditional features of psychopathy but is incongruent with the formal diagnostic criteria in many ways. The "Associated Features" section of the text contains a statement parahrased by Robert Hare: "Lack of empathy, inflated and arrogant self-appraisal, and glib, superficial charm are features of ASPD that may be particularly useful in prison or forensic settings wherein criminal, delinquent and aggressive acts will be less specific to the disorder". [27]
The problem that this presents is that the words used to describe these and related affective and interpersonal features are those typically associated with psychopathy and were based heavily on the 10-item psychopathic personality disorder set derived from the PCL-R. One is compelled to conclude that DSM-IV contains two sets of diagnostic criteria for ASPD, one consisting of antisocial and criminal behaviors, and the other consisting of these behaviors plus clinical inferences about personality. What is worse, the clinician is not given any guidelines on how to make these inferences.
One of the consequences of the ambiguity inherent in DSM-IV ASPD/ psychopathy criteria is that it leaves the door open for court cases wherein one clinician can say that the defendant meets the DSM-IV definition of ASPD, and another clinician can say he does not, and both can be right! The first clinician can use the formal diagnostic criteria exclusively while the second clinician can say "yes, the defendant may meet the formal criteria, but he or she does not have the personality traits described in the "Associated Features" section of the DSM-IV text". In other words, a good psychopath with a good lawyer can commit any crime and get away with it.
This failure of the DSM-IV to differentiate between psychopathy and ASPD can (and undoubtedly will) have very serious consequences for society. Robert Hare writes:
... most jurisdictions consider psychopathy to be an aggravating rather than a mitigating factor in determining criminal responsibility. In some states an offender convicted of first-degree murder and diagnosed as a psychopath is likely to receive the death penalty on the grounds that psychopaths are cold-blooded, remorseless, untreatable and almost certain to reoffend. But many of the killers on death row were, and continue to be, mistakenly referred to as psychopaths on the basis of DSM-III, DSM-III-R or DSM-IV criteria for ASPD (Meloy). We don't know how many of these inhabitants of death row actually exhibit the personality structure of the psychopath, or how many merely meet the criteria for ASPD, a disorder that applies to the majority of criminals and that has only tenuous implications for treatability and the likelihood of violent reoffending. If a diagnosis of psychopathy has consequences for the death penalty - or for any other severe disposition, such as an indeterminate sentence or a civil commitment - clinicians making the diagnosis should make certain they do not confuse ASPD with psychopathy. [...] Diagnostic confusion about the two disorders has the potential for harming psychiatric patients and society as well.
Camouflage Society
In my book, Without Conscience, I argued that we live in a "camouflage society," a society in which some psychopathic traits - egocentricity, lack of concern for others, superficiality, style over substance, being "cool," manipulativeness, and so forth - increasingly are tolerated and even valued. ... it is easy to see how both psychopaths and those with ASPD could blend in readily with groups holding antisocial or criminal values. It is more difficult to envisage how those with ASPD could hide out among more prosocial segments of society. Yet psychopaths have little difficulty infiltrating the domains of business, politics, law enforcement, government, academia and other social structures (Babiak). It is the egocentric, cold-blooded and remorseless psychopaths who blend into all aspects of society and have such devastating impacts on people around them who send chills down the spines of law enforcement officers.
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Psychopathy's relationship with other mental health disorders
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Controversy
The issue of comorbidity is a topic of dispute between the above-mentioned schools of thought and the problems of the DSM-IV already discussed. It appears that the comorbidity of psychopathy with other psychiatric disorders is limited and confused. [28] Many of the traits that are commonly used to define psychopathy - impulsivity, egocentricity, callousness, irresponsibility, etc - also manifest in other disorders in varying combinations. In this respect, psychopathy is similar to the personality disorders defined in the DSM-IV. As mentioned above in the history section, according to Eastern European psychologist, Andrzej Łobaczewski, the clinicians of the old European school maintained that there were several types of psychopathy including asthenic, schizoidal, anankastic, hysterical.[29]
Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. PCL-R Factor 1 is correlated with narcissistic personality disorder and histrionic personality disorder. PCL-R Factor 1 is associated with extroversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).
PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality. PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence.
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Prevalence of Psychopathy
Estimates of the prevalence of any disorder of course depend on how the disorder is defined, how it is assessed, who is doing the assessment and why. Obviously, if there are political reasons to conceal the prevalence of psychopathy (i.e., that there are psychopaths in positions of political power, to which they gravitate naturally and have the skills to achieve), then the definition and assessment will be designed to utilize the category for political reasons.
In a recent paper, [30] the authors state:
Psychopathy, as originally conceived by Cleckley (1941), is not limited to engagement in illegal activities, but rather encompasses such personality characteristics as manipulativeness, insincerity, egocentricity, and lack of guilt - characteristics clearly present in criminals but also in spouses, parents, bosses, attorneys, politicians, and CEOs, to name but a few. (Bursten, 1973; Stewart, 1991). Our own examination of the prevalence of psychopathy within a university population suggested that perhaps 5% or more of this sample might be deemed psychopathic, although the vast majority of those will be male (more than 1/10 males versus approximately 1/100 females).
As such, psychopathy may be characterized ... as involving a tendency towards both dominance and coldness. Wiggins (1995) in summarizing numerous previous findings... indicates that such individuals are prone to anger and irritation and are willing to exploit others. They are arrogant, manipulative, cynical, exhibitionistic, sensation -seeking, Machiavellian, vindictive, and out for their own gain. With respect to their patterns of social exchange (Foa & Foa, 1974), they attribute love and status to themselves, seeing themselves as highly worthy and important, but prescribe neither love nor status to others, seeing them as unworthy and insignificant. This characterization is clearly consistent with the essence of psychopathy as commonly described.
The present investigation sought to answer some basic questions regarding the construct of psychopathy in non forensic settings... In so doing we have returned to Cleckley's (1941) original emphasis on psychopathy as a personality style not only among criminals, but also among successful individuals within the community.
What is clear from our findings is that (a) psychopathy measures have converged on a prototype of psychopathy that involves a combination of dominant and cold interpersonal characteristics; (b) psychopathy does occur in the community and at what might be a higher than expected rate; and (c) psychopathy appears to have little overlap with personality disorders aside from Antisocial Personality Disorder. ...
Clearly, where much more work is needed is in understanding what factors differentiate the law abiding (although perhaps not moral-abiding) psychopath from the law-breaking psychopath; such research surely needs to make greater use of non forensic samples than has been customary in the past.
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Psychopathy in Children
"If you're antisocial but you come from a good home, the reasons for your violent behavior may have more to do with biology than your upbringing," says University of Southern California psychophysiologist Adrian Raine, Ph.D.
In 1979, sixteen-year-old Brenda Spencer received a rifle for her birthday. She used it to shoot children at an elementary school near her home (San Diego). Nine were wounded, two died. A reporter asked her later why she had done it and she answered "I don't like Mondays. This livens up the day."
In 1986, nine-year-old Jeffrey Bailey, Jr. pushed a three-year-old friend into the deep part of a motel pool in Florida because he wanted to see someone drown. As the child sank to the bottom of the pool, Jeffrey pulled up a deck chair to watch. When it was over, he went just got up and went home. When he was questioned, he was more interested in the fact that he was the center of attention than feeling remorse for what he had done.
On April 13, 2000, three first-graders in north-western Indiana were interrupted in the act of plotting to kill a classmate. They had formed a "hate" club and were trying to recruit other girls to join them in the planned slaughter. They were not yet sure whether they would shoot their target victim, stab her with a butcher knife or hang her.
These cases, and many more besides, make it increasingly clear that psychopathy is not exclusively an adult problem. Some child development experts believe that childhood psychopathy is increasing at an alarming rate. In the research, these children are regarded as "fledgling psychopaths" who will become increasingly more dangerous as they get older. As the research shows, most of them will not become killers but they certainly will learn better how to manipulate, deceive and exploit others for their own gain.
Some researchers believe that such children have failed to develop affectional bonds that allow them to empathize with another's pain and have, instead, developed traits of arrogance, dishonesty, narcissism, shamelessness, and callousness.
As noted above, over many years, the criteria for a diagnosis of psychopathy in adults has gone through a number of confusing conceptual changes. Psychopaths have been called sociopaths but they've also been distinguished as a separate and distinct group from sociopaths. The other complicating factor discussed above is the development of the diagnosis of Antisocial Personality Disorder, which overlaps with many traits of a psychopath but also has key differences. Therefore, it is not a surprise that juvenile psychopathy, too, has been poorly defined and confused with various youthful conduct disorders or that children have been diagnosed with conduct disorders who really should be diagnosed as psychopaths.
In the movie, The Bad Seed (1956), based on the novel 1954) by the same name, the psychopathic child, Rhoda, was depicted as cute, adorable, manipulatively affectonate, and deadly. The author of the book, William March was influenced by the work of Hervey Cleckley. Wikipedia erroneously states that the term "psychopath" was not in use at the time the book was written.[31]
In Without Conscience Robert Hare quotes from The Bad Seed:
Good people are rarely suspicious: they cannot imagine others doing the things they themselves are incapable of doing; usually they accept the undramatic solution as the correct one, and let matters rest there. Then too, the normal are inclined to visualize the [psychopath] as one who's as monstrous in appearance as he is in mind, which is about as far from the truth as one could well get . . . These monsters of real life usually looked and behaved in a more normal manner than their actually normal brothers and sisters; they presented a more convincing picture of virtue than virtue presented of itself - just as the wax rosebud or the plastic peach seemed more perfect to the eye, more what the mind thought a rosebud or a peach should be, than the imperfect original from which it had been modeled.
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Nature or Nurture?
Are psychopaths born or made?
Robert Hare suggests that both dimensions are implicated.[32] J. Reid Meloy writes:
...a child comes into the world with a certain genotype that is phenotypically expressed according to the vagaries of personal experience. [33]
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The Instinctive Substratum or Psychobiological Foundation
Andrzej Lobaczewski discusses the role played by what he calls the instinctive substratum. He writes:
Man’s instinctive substratum has a slightly different biological structure than that of animals. Energetically speaking, it has become less dynamic and become more plastic, thereby giving up its job as the main dictator of behavior. It has become more receptive to the controls of reasoning, without, however, losing much of the rich specific contents of the human kind. ... This substratum contains millions of years’ worth of bio-psychological development that was the product of the species’ life conditions, so it neither is nor can be a perfect creation. Our well known weaknesses of human nature and errors in the natural perception and comprehension of reality have thus been conditioned on that phylogenetic level for millennia.[...]
Man has lived in groups throughout his prehistory, so our species’ instinctual substratum was shaped in this tie, thus conditioning our emotions as regards the mining of existence. The need for an appropriate internal structure of commonality, and a striving to achieve a worthy role within that structure, are encoded at this very level. [...]
Our zeal to control anyone harmful to ourselves or our group is so primal in its near-reflex necessity as to leave no doubt that it is also encoded at the instinctual level. [...]
It is also at this level that differences begin to occur between normal individuals, influencing the formation of their characters, world views, and attitudes. The primary differences are in the bio-psychical dynamism of this substratum; differences of content are secondary. For some people the sthenic instinct supersedes psychology; for others, it easily relinquishes control to reason. It also appears that some people have a somewhat richer and more subtle instinctual endowment than others. Significant deficiencies in this heritage nevertheless occur in only a tiny percentage of the human population; and we perceive this to be qualitatively pathological. [34]
J. Reid Meloy writes, along the same lines:
"The house of psychopath" is built on a psychobiological foundation of no attachement, underarousal, and minimal anxiety. ...
Attachment is a biologically rooted, species-specific behavioral system that maintains close proximity between child and caretaker. It was first conceptualized and investigated by John Bowlby, James Robertson, and Mary Ainsworth at the Tavistock Clinic in London (Robertson and Bowlby, 1952; Bowlby, 1953; Ainsworth and Bowlby, 1954). Attachment is deeply rooted in both birds and mammals but is generally absent in reptiles.
[35]
References to a "reptilian nature" of psychopaths occurs elsewhere in Meloy's work:
The other clinical observation that supports the hypothesis of a reptilian state among certain primitive psychopathic characters is the absence of perceived emotion in their eyes. Althought this information is only intuitive and anecdotal, it is my experience in forensic treatment and custody settings to hear descriptions of certain patients' or inmates' eyes as cold, staring, harsh, empty, vacant, and absent of feeling. Reactions from staff to this percetion of the psychopath's eyes have included, "I was frightened... he's very eerie; I felt as if he was staring right through me; when he looked at me the hair stood up on my neck."
This last comment is particularly telling since it captures the primitive, autonomic, and fearful response to a predator.
I have rarely heard such comments as these from the same experienced inpatient staff during highly arousing, threatening, and violent outbursts by other anger, combative patients. It is as if they sense the absence of a capacity for emotional relatedness and empathy in the psychopathic individual, despite his lack of actual physical violence at the moment. ...
I have found little in the research literature, either theoretical or empirical, that attempts to understand this act of visual predation in the psychopathic process. ... The fixated stare of the psychopath is a prelude to instinctual gratification rather than empathic caring. The interaction is socially defined by parameters of power rather than attachment. [36]
The curious references to a perception of the psychopath as being reptilian in essence is also suggested by Andrzej Lobaczewski, who writes about the effect of the psychopath on the normal human:
When the human mind comes into contact with this new reality so different from any experiences encountered by a person raised in a society dominated by normal people, it releases psychophysiological shock symptoms in the human brain with a higher tonus of cortex inhibition and a stifling of feelings, which then sometimes gush forth uncontrollably. Human minds work more slowly and less keenly, since the associative mechanisms have become inefficient. Especially when a person has direct contact with psychopathic [individual] who use their specific experience so as to traumatize the minds of the "others" with their own personalities, his mind succumbs to a state of short-term catatonia. Their humiliating and arrogant techniques, brutal paramoralizations, deaden his thought processes and his self-defense capabilities, and their divergent experiential method anchors in his mind. ...
Only after these unbelievably unpleasant psychological states have passed, thanks to rest in benevolent company, is it possible to reflect - always a difficult and painful process - or to become aware that one's mind and common senses have been fooled by something which cannot fit into the normal human imagination. [37]
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The Reptilian Brain
According to theories of evolution, about a half billion years ago, many different types of vertebrates proliferated wildly over the earth's land surface. This was followed by a large variety of insects, amphibians and eventually the first dinosaurs. Over time, the brain also evolved in response to the effects of the continually changing environment. The limbic system and "reptilian brain" of more primitive life forms have not been replaced, but merely expanded upon.
The brain develops as a series of four separate brains, each with its own memory, motor and other functions. Each brain elaborates on the preceding level and adds increasing degrees of organization and self-preservation capacity to the vegetative functions of the hindbrain, midbrain, and spinal cord. The first "brain" described by Maclean is this "reptilian brain." This part of the brain is responsible for primitive levels of genetically transmitted knowing that result in repetitive and ritualistic migratory, territoriality, aggression and courtship behaviors. Maclean describes an important achievement of the reptilian brain as "homing", or the tendency to return to a recognized frame of reference after reaching out for a mate or food, etc. Mahoney relates this to the development of human "reality," which is our creation of an orderly and temporally stable world.
The second "brain" to develop is the limbic system, or "paleomammalian brain". This level integrates and refines life-relevant behavior patterns (feeding, aggression, and reproduction) and is best known for its role in emotional intensity and motivational complexity (Mahoney, 1991). The limbic system coordinates homeostatic life support, purposive action, memory, learning, and emotionality. As such, it involves its own primitive form of reflective intelligence and self-regulatory control.
The third, or "neomammalian" brain, also known as the "neocortex", accounts for 85% of the entire adult human brain. The frontal area, which is associated with higher level mental organization, intentionality, and self- awareness, is over six times as large as that of non-human primates of similar size (Mahoney, 1991). Mahoney cautions against thinking that, because it develops later, the rational intellectual functions of the neocortex enable it to override or control the passions of the limbic brain. Although under inhibitory control of the neocortex, parts of the limbic system with their primitive survival functions, can override neocortical control.(Joseph, 1992; Joseph, 1993; Mahoney, 1991).
The fourth human brain is seen in differentiation of the neocortex into two separate and independently functioning "higher brains" or cerebral hemispheres. In his original description of "the triune brain," MacLean denied the need to describe this fourth level of independent brain functioning, however the majority of modern neuroscientists have disagreed (Mahoney, 1991). Differentiation of these four brain systems and concomitant changes in emotion and thought occur primarily during early childhood, but continue into adolescence and even adulthood. When most of us see another persons distress, our emotional center, the limbic system, is aroused. We feel a little of what others are feeling. Hare and his colleagues (using functional magnetic resonance imaging (fMRI)) studied the neurological manifestations of the way psychopaths process different types of words. When non-psychopaths processed negative emotional words (e.g., rape, death, cancer), activity in the limbic regions of the brain increased. For psychopaths there was little or no increased activity in these regions.
In the Journal of Biological Psychiatry, Adrian Raine at the University of California explains that the brains of murderers, on average, have significantly lower rates of glucose uptake than the healthy brain of the control subjects. Raine, noted "Poor functioning of these limbic area helps explain why violent offenders fail to learn from experience and are less able to regulate their emotions.” [38]
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Failure of Nurture - Bonding?
Many researchers are biased toward - and cling to - a "nurturing failure" explanation for psychopathy. Regarding this, Meloy notes:
...[T]he importance of biology in ... psychopathy should not be dismissed (Raine, 1993; Cooke, Forth, and Hare, 1998)... Studies have shown that psychopathy has a negative curvilinear relationship to neglectful and abusive childhood family experiences (Marshall and Cooke, 1999). In other words, those persons who are severely psychopathic were less influenced by family factors when they were growing up; whereas those with low-to-moderate psychopathy were strongly influenced by family experience. Neuroimaging (PET) also suggests that functional deficits measured by radioactive glucose among samples of murderers with extensive criminal histories are more pronounced among those from good rather than poor home environments (Raine, Stoddard, et al., 1998) [39]
Meloy describes the psychopath as follows:
The psychopath is an imposter. Shorn of any deep and abiding identifications with others, much of his subsequent behavior as an adult involves the conscious imitation and simulation of other people's thoughts, affects, and activities. ... I am using the term imitation to describe the intentional, conscious, mimicking of another person's attitudes or behavior. ...
Unlike the person with narcissistic personality disorder who consciously feels, at times, a sense of being a fake, the psychopathic character has no awareness of this "false self" or the "as if" quality of his phenomenal experience. He does not merely play the role, observing the limits of his character, but lives the part.
The psychopathic process may also be expressed by individuals whose simulations are so adept, whether they be cognitive, affective, or behavioral, that there is absolutely no suspicion whatsoever that pseudo-identifications may be occurring. This is especially difficult to assess in the socially engaging and intelligent psychopath. ... Any successful assessment of the nature and genuineness of identifications in these individuals must be largely dependent upon corroborative information from relatives, family, acquaintances, and other clinicians. [40]
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DSM-IV APD and Children
Antisocial Personality Disorder is described in DSM-IV as ‘a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood… This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder’. [41] This confusion of terminology, discussed above, is especially damaging for research because while DSM-IV describes APD as ‘associated with low socio-economic status’ [42] psychopathy ‘seems less likely to be associated with social disadvantage or adversity’. [43]
Psychopathy is not associated with low birth weight, obstetric complications, poor parenting, poverty, early psychological trauma or adverse experiences, and indeed Robert Hare remarks ‘I can find no convincing evidence that psychopathy is the direct result of early social or environmental factors’. [44]
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Cloninger’s Two-threshold Model for Inherited Psychopathy
Cloninger’s ‘two-threshold’ model suggests a polygenic and sex-limited contribution to psychopathy according to which more men than women would pass the threshold for activation of predisposing genes. This model predicts that males should be more susceptible to environmental influences and females who do become psychopathic should have a greater genetic predisposition; this is confirmed by the finding that the offspring of female psychopaths are more vulnerable than those of male psychopaths. [45]
One feature of psychopathy is that extremely violent and antisocial behaviour appears at a very early age, often including casual and thoughtless lying, petty theft, a pattern of killing animals, early experimentation with sex, and stealing. [46] In a study of 653 serious offenders, childhood problem behaviors provided convergent evidence for the existence of psychopathy as a discrete class, but ‘adult criminal history variables were continuously distributed and were insufficient in themselves to detect the taxon’. [47] In another study psychopathic male offenders were found to score lower than nonpsychopathic offenders on obstetrical problems and fluctuating asymmetry. The offenders meeting the most stringent criteria for psychopathy had the lowest asymmetry scores amongst offenders. [48]
Professor Adrian Raine directed a study in which scientists from USC and the University of California at Irvine used positron emission tomography (PET) to scan the brains of 38 men and women charged with murder. Some of the subjects had pleaded not guilty by reason of insanity, while the rest had been found incompetent to stand trial.
PET scans measure the uptake of blood sugar (glucose) in various brain areas during the performance of simple, repetitive tasks. (Glucose is the basic fuel that powers most cell functions. The amount used is related to the amount of cell activity.)
The researchers waded through piles of court records, attorney interviews, medical and psychological records, and newspaper articles searching for evidence about the subjects' upbringing; whether or not they had experienced physical or sexual abuse, neglect, extreme poverty, foster home placement, severe family conflict, a broken home, having a criminal parent -- all environmental risks commonly associated in people's minds with a propensity for violence.
The researchers rated the severity of the risks they found on a five-point scale, with 0 representing no abuse, 1 minimal, 2 partial, 3 substantial and 4 extreme.
Of the 38 murderers, only 12 were found to have suffered significant psychosocial abuse and deprivation (ratings 2 to 4). The remaining 26 were found to have experienced minimal abuse and deprivation or none (ratings 0 - 1).
Compared to the subjects from the assessed bad early environments, the 26 subjects from benign backgrounds averaged 5.7% less activity in the medial prefrontal cortex. More significantly, one particular part of the medial prefrontal cortex -- the orbifrontal cortex on the right hemisphere -- showed 14.2% less activity.
"Parents of violent kids think, 'What did I do wrong?'" says Raine, a professor of psychology in USC's College of Letters, Arts and Sciences. "When the kids come from a good home, the answer may be absolutely nothing. A biological deficit may be to blame."
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Diagnosing Psychopathy in Children
Psychopathy is not normally diagnosed in children or adolescents, and some jurisdictions explicitly forbid diagnosing psychopathy and similar personality disorders in minors. Psychopathic tendencies can sometimes be recognized in childhood or early adolescence and, if recognised, are diagnosed as conduct disorder. It must be stressed that not all children diagnosed with conduct disorder grow up to be psychopaths, or even disordered at all, but these childhood signs are found in significantly higher proportions in psychopaths than in the general population.
Children showing strong psychopathic precursors often appear immune to punishment; nothing seems to modify their undesirable behavior. Consequently parents usually give up, and the behavior worsens.[49]
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Indicators of Psychopathy in Childhood
For some time, under the influence of the DSM-III, it was said that indicators of psychopathy in childhood included the following:
* A longer-than-usual period of enuresis bedwetting
* Cruelty to animals
* Firesetting and other vandalism.
* Lies
* Truancy
* Theft
* Aggression to peers
* Defiance of authority
The three indicators, bedwetting, cruelty to animals and firestarting, known as the MacDonald triad, were first described by J.M. MacDonald as indicators of psychopathy[50]. The relevance of enuresis to the etiology of psychopathy has since been called into question by MacDonald himself. [50] The latest information suggests that urinary incontinence is more likely to be a problem associated with social expectations and developmental delays. Historically, enuretic children have been subjected to distressing and painful methods of treatment, i. e., medications, mechanical devices, and pharmacologic preparations, to the point of permanent disability which certainly might cause conduct reactions. The modern emphasis on the problem of enuresis is focused on successful use of behavioral therapies and meaningful parent and child reeducation. Nevertheless, having been suggested (and accepted) as a sign of childhood psychopathy, the label is difficult to remove.
The question of whether young children with these alleged early indicators of psychopathy respond poorly to intervention compared to conduct disordered children without these traits has only recently been examined in controlled clinical research. The findings from this research are consistent with broader evidence - pointing to poor treatment outcomes. [51]
Another study suggests that psychopaths have a genotype that results in an "inborn temperament or personality, coupled with a particular pattern of autonomic hypoarousal that, together, design the child to be selectively unresponsive to the cues necessary for normal socialization and moral development" [52]
Given the weakness of evidence for developmental instability and brain damage in psychopaths, attention should be paid to the probability that child psychopaths are mislabelled as suffering from Attention Deficit Hyperactivity Disorder, Conduct Disorder, or Oppositional Defiant Disorder. According to Hare ‘none of these diagnostic categories quite hits the mark with young psychopaths. Conduct disorder comes closest, but it fails to capture the emotional, cognitive, and interpersonal personality traits… that are so important in the diagnosis of psychopathy’ [53]
