An Introduction to Psychopathy

I am still surprised by the amount of disagreement about psychopathy, sociopathy, antisocial personality disorder, etc. that you'll get from any source -- academic, pop psychology, etc. With that small caveat (nothing is definitive), I found this article on psychopathy to be a good overview with academic cites (and links in the original). Here are some selections:

While it is past antisocial behavior that is particularly important in predicting future criminal activity (Walters, 2003), it is CU (callous unemotional) traits that are at the core of developmental trajectory associated with psychopathy (Frick and White, 2008). The disorder is developmental. It has been shown that CU traits in particular and the psychopathy more generally are relatively stable from childhood into adulthood (Lynam et al., 2007; Munoz and Frick, 2007). In addition, the functional impairments seen in adults with psychopathy (e.g., in responding to emotional expressions, aversive conditioning, passive avoidance learning, reversal learning, extinction) are also seen in adolescents with psychopathic tendencies (see later).
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Psychopathy is not equivalent to the psychiatric conditions of conduct disorder (CD) or antisocial personality disorder (ASPD) as defined by DSM-5 or their ICD-10 counterparts. The diagnostic criteria for these disorders focus on antisocial behaviors rather than on etiological factors such as the emotion dysfunction seen in psychopathy (Blair et al., 2005). As such these psychiatric conditions describe individuals with difficulties in executive dysfunction (Moffitt, 1993), as well as individuals with symptoms stemming from CU traits. Consequently, individuals with psychopathy are a more homogenous group than those individuals meeting the criteria for CD and ASPD (Karnik et al., 2006). It should be noted, however, that DSM-5 includes the specifier for CD ‘with limited pro-social emotions,’ which stem directly from research on youth with CD and CU traits (Pardini et al., 2010; Pardini and Fite, 2010). Furthermore, the diagnosis of ASPD now includes components of psychopathy (APA, 2013). While the disorder of psychopathy will still not be equivalent to the DSM-5 diagnoses of CD and ASPD, there will be greater overlap in diagnostic conceptualization.

Psychopathy is characterized by an increased risk for antisocial behavior (Frick and Dickens, 2006; Hare, 2003). While several psychiatric disorders and neurological conditions, including CD and ASPD (APA, 2013), confer an increased risk of reactive aggression (Anderson et al., 1999; Leibenluft et al., 2003), psychopathy is unique in that it conveys increased risk for instrumental aggression (Frick et al., 2003). 

Interestingly, an article that was cited included this assessment of treatment options: "While treatment recommendations are currently sparse, recent work has shown that previous assessments of treatment amenability in this population may have been overly pessimistic."

Also, because I had to look this up too:
"A classic measure of stimulus-reinforcement learning is aversive conditioning -- the individual learns that a particular stimulus is associated with threat. Individuals with elevated CU traits show marked impairment in stimulus-reinforcement learning. Indeed, an individual's ability to perform aversive conditioning at 15 years has predictive power regarding whether that individual will display anti-social behavior 14 years later (Raine et a., 1996)."

An aspie's view of sociopathy

From an Aspie reader reader:

I found your blog by chance, a week or two ago, and can't help but feel intrigued. I have Asperger's syndrome (or as the next version of the DSM has it, "autism spectrum disorder") and the experiences you describe seem to have as many similarities to as differences from my own. 

We both find it necessary to mask ourselves for daily life because most people, most of the time, don't want to know what we're really like. They want an interface they know how to use, and an impression they can easily categorize. I don't switch masks with the fluidity of a sociopath, nor do I have as large a repertoire to choose from. I'd be willing to bet that I have to put more conscious effort into each one, so once a given mask passes I have greater incentive to stick with it and practice until perfect. (I don't know what you look like without yours, but at times when I can't maintain a mask I've been told that I either don't emote, or that the other (neurotypical) person doesn't know how to interpret my body language.)

Changing contexts, some facets of my personality behind that mask may fold away and others unfold such that people in either seem to form substantially different impressions of me, but I don't make a conscious decision to change what aspects I have on display, nor bother with deception. I simply omit what isn't relevant.

On the other hand, I'm pretty sure that I lack the typical sociopaths' need for stimulation and excitement, nor do any of your examples mention sociopaths with a typical autistics' sensory hypersensitivities. Sitting in a quiet room with dim lights, my experience is finally not *over*stimulating.

In that vein, there's one thing that I really don't understand. What do sociopaths get out of manipulating or otherwise having power over other people? What about it interests you? To my view, people are mostly boring and interacting with them is a nontrivial drain on my resources. (There are rare exceptions to that rule, and I've married one. He describes me as "asocial".) And so I have to ask: Why bother?

I look forward to your answer.

My response:

Thanks for this! I think that sociopaths get a lot of things from power. They get a sense of connection and intimacy with another person. They get a sense of purpose or sense that they are a being in the world that acts, not just gets acted upon. I think for a lot of sociopaths there was some sort of childhood trauma that made them feel like they weren't the masters of their own destiny. Not everyone is bothered by this, but I think for sociopaths it goes too strongly against their megalomania. But these are sort of just guesses. For me I have felt the need for power as a basic need, like the need for love or acceptance must be for most people, but I'm not sure why. Thoughts?

DSM-5 = "lack of validity"

Says the Dr. Thomas R. Insel, director of the National Institute of Mental Health. From the NY Times:


While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

Insel describes the problem of all psychiatric diagnoses:

“Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.”

It's interesting, a lot of people will come on here and baldly assert, "sociopaths don't do this" or "that's not what borderline personality disorder is." And that's fine. I understand the flaws and ambiguities in my own working definitions of psychiatric disorders. And I also understand that despite the fuzziness of the definitions, it's still useful to acknowledge that there seems to be commonalities between certain categories of people that deserve further explanation. But I do believe that people have used the DSM unquestioningly for far too long, taking it to the level of being DSM apologists rather than accepting new information with an open-mind, and I'm glad that there is now more pressure to provide actual science behind the various assertions.

For more on the DSM-5's explicit rejection in one instance of actual scientific proof of a separate psychiatric disorder, see this New Yorker article's discussion of melancholia:

[T]he inclusion of a biological measure [for melancholia] would be very hard to sell to the mood group." Coryell explained that the problem wasn’t the test’s reliability, which he thought was better than anything else in psychiatry. Rather, it was that the D.S.T. would be "the only biological test for any diagnosis being considered." A single disorder that met the scientific demands of the day, in other words, would only make the failure to meet them in the rest of the D.S.M. that much more glaring.
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This notion—that the apparent mental condition is all that can matter—underlies not only the depression diagnosis but all of the D.S.M.’s categories. It may have been conceived as a stopgap, a way to bide time until the brain’s role in psychological suffering has been elucidated, but in the meantime, expert consensus about appearances has become the cornerstone of the profession, one that psychiatrists are reluctant to yank out, lest the entire edifice collapse.

"What can be asserted without evidence can be dismissed without evidence."