Notes on Psychopathy

by gwern34 min read19th Dec 2012100 comments


PsychopathyPsychologyWorld Modeling
Personal Blog

This is some old work I did for SI. See also Notes on the Psychology of Power.

Deviant but not necessarily diseased or dysfunctional minds can demonstrate resistance to all treatment and attempts to change their mind (think No Universally Compelling Arguments; the premier example are probably psychopaths - no drug treatments are at all useful nor are there any therapies with solid evidence of even marginal effectiveness (one widely cited chapter, “Treatment of psychopathy: A review of empirical findings”, concludes that some attempted therapies merely made them more effective manipulators! We’ll look at that later.) While some psychopath traits bear resemblance to general characteristic of the powerful, they’re still a pretty unique group and worth looking at.

The main focus of my excerpts is on whether they are treatable, their effectiveness, possible evolutionary bases, and what other issues they have or don’t have which might lead one to not simply write them off as “broken” and of no relevance to AI.

(For example, if we were to discover that psychopaths were healthy human beings who were not universally mentally retarded or ineffective in gaining wealth/power and were destructive and amoral, despite being completely human and often socialized normally, then what does this say about the fragility of human values and how likely an AI will just be nice to us?)

As usual in my 'notes' articles, the following is a series of excerpts and citations; if any interest you, leave a comment and I will try to jailbreak a copy for you or failing that, post a request on the research help page.

1 Psychopathy

The Psychopath: Emotion and the brain, Blair et al 2005:

There are now a relatively large number of studies indicating that individuals with psychopathy reoffend at higher rates than non-psychopathic individuals. For example, in an early study, the PCL-R was administered to 231 offenders prior to release from prisons (Hart et al., 1988). Within 3 years, 25% of non-psychopathic individuals had been re-incarcerated. In sharp contrast, 80% of the individuals with psychopathy had breached the terms of their release. In another study Serin and Amos (1995) followed 299 offenders, and within 3 years, 65% of individuals with psychopathy versus only 25% of the non-psychopathic individuals were convicted of a new offence. Such results have been found in European studies also. Thus, in a Swedish sample of forensic patients, Grann et al. (1999) found that individuals scoring above 25 on the PCL-R violently reoffended at a rate of 66% versus only 18% for those with a score less than 26. In Belgium, the reconviction rates of psychopathic, middle scoring, and low scoring individuals were 44% , 21% , and 11% , respectively (Hare et al., 2000)…An international study of 278 offenders is of particular interest. This found that 82% of the individuals with psychopathy but only 40% of non- psychopathic individuals were reconvicted of an offence (Hare et al., 2000). In the same group, 38% of the high psychopathy group committed a violent offence, but only 2.7% of those with a low PCL-R score did. Interestingly, both the individuals with psychopathy and the non-psychopathic individuals failed to show attenuated reconviction rates following treatment after controlling for age and criminal history. However, the pattern of results changes when Factor 1 scores [interpersonal/affective: glib charm, grandiosity, lying, callosity, cunning] are carefully examined. Participants with high Factor 1 scores reoffended at higher rates if they had been treated: 86% as opposed to 59% ! Similarly striking results have been seen when examining participants who engage in educational and vocational training programs. Here offenders with low Factor 1 scores show an improvement in recidivism rate following the course. However, offenders with high Factor 1 scores are reconvicted at higher rates if they take part in these programs rather than if they do not. In what is perhaps the most comprehensive review and meta-analysis to date, Hemphill and colleagues (1998) examined nine available published and unpublished prospective studies of psychopathy and recidivism. The length of followup for the studies reviewed ranged from 1 to 10.5 years. The authors determined that within a year of release, individuals with psychopathy are three times more likely to recidivate, and four times more likely to recidivate violently. In fact, the relative risk for reoffending (the proportion of psychopathic individuals who reoffend divided by the proportion of non-psychopathic offenders who reoffend) ranged from 1.7 to as high as 6.5 across studies. Taken together, at a 1-year follow-up, the general recidivism rate for individuals with psychopathy was three times higher than that of non-psychopathic individuals and the violent recidivism rate was three to five times higher. Psychopathy is associated with both general and violent recidivism at follow-up lengths of as little as a year, or as long as more than 10 years.

  • Hart S. D., Kropp P. R., Hare R. D. (1988). Performance of male psychopaths following conditional release from prison. Journal of Consulting and Clinical Psychology, 56, 227-232
  • Serin R. C., Amos N. L. (1995). The role of psychopathy in the assessment of dangerousness. International Journal of Law and Psychiatry, 18, 231-238
  • Grann M., Langstrom N., Tengstrom A., Kullgren G. (1999). Psychopathy (P. C. L-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden. Law and Human Behavior, 23, 205-217.
  • Hare R. D., Clark D., Grann M., Thornton D. (2000). Psychopathy and the predictive validity of the P. C. L-R: an international perspective. Behavioral Sciences and the Law, 18, 623-645
  • Hemphill J. F., Hare R. D., Wong S. (1998). Psychopathy and recidivism: a review. Legal and Criminological Psychology, 3, 139-170

However, preliminary work conducted by Paul Frick using the APSD has examined the incidence rate of psychopathic tendencies in community samples involving children. As discussed in chapter 1, we have used a score of 27 on the APSD as our cut-off point for a classification of psychopathic tendencies in many of our studies (Blair et al., 2001a, b). Using this cut-off results in a prevalence rate of psychopathic tendencies of between 1.23% and 3.46% (Frick, personal communication); i.e., approximately one quarter of the incidence rate of CD in community samples. Moreover, epidemiological studies examining the prevalence of psychopathy in forensic samples have been conducted. These reveal that while up to 80% of US inmates reach diagnostic criteria for ASPD, only 15-25% of US inmates meet criteria for psychopathy according to the criteria laid down by the PCL-R (Hare, 1996). In other words, approximately one quarter of those receiving the DSM-IV diagnosis of ASPD meet the criteria for psychopathy. Based on these findings and the 3% community incidence rate of ASPD suggested by the DSM-IV, the prevalence of psychopathy can be inferred. If we assume approximately 25% of those with a diagnosis of ASPD might meet criteria for psychopathy, we can estimate an incidence rate for psychopathy in males in the community of 0.75%.

  • Blair R. J. R., Colledge E., Mitchell D. G. (2001a). Somatic markers and response reversal: is there orbitofrontal cortex dysfunction in boys with psychopathic tendencies? Journal of Abnormal Child Psychology, 29(6), 499-511.
  • Blair R. J. R., Colledge E., Murray L., Mitchell D. G. (2001b). A selective impairment in the processing of sad and fearful expressions in children with psychopathic tendencies. Journal of Abnormal Child Psychology, 29(6), 491-498
  • Hare R. D. (1996). Psychopathy: a clinical construct whose time has come. Criminal Justice and Behavior, 23, 25-54

Hare and colleagues, using the Wechsler Adult Intelligence Scale, found little correlation between IQ and both PCL-R total scores and emotional dysfunction (Factor 1) scores. However, there was a modest negative correlation with antisocial behavior (Factor 2 [Impulsive/antisocial lifestyle: delinquency, parasitism, no long-term goals]) scores (Hare, 1991); i.e., lower IQ was associated with higher levels of antisocial behavior. Similar findings have been reported with children with psychopathic tendencies (Frick et al., 1994). Similarly, Hare, using a battery of tests that measure over 20 mental abilities, found no correlation between cognitive functioning and Factor 1 or total PCL-R scores, but did find a significant negative correlation (r = −0.46) between Factor 2 and “crystallized intelligence” (Hare, 2003). Crystallized intelligence can be considered a measure of accumulated knowledge. It is highly influenced by an individual’s experience (i.e., their schooling and involvement in cultural activities). Moreover, Hare, in a comprehensive review, reports a consistent, though modest, negative correlation between education and Factor 2, but not Factor 1, scores (Hare, 2003). Overall, then, there is no evidence to suggest that individuals with psychopathy have superior IQ compared to individuals with no psychopathy. However, antisocial behavior does appear to be linked with lower intelligence and lower level of schooling.

  • Hare R. D. (1991). The Hare Psychopathy Checklist - Revised. Toronto, Ontario: Multi-Health Systems
  • Frick P. J., O’Brien B. S., Wootton J. M., McBurnett K. (1994). Psychopathy and conduct problems in children. Journal of Abnormal Psychology, 103, 700-707
  • Hare R. D. (2003). The Hare Psychopathy Checklist - Revised (PCL-R), 2nd edn. Toronto, Ontario: Multi-Health Systems.
  • psychopathy uncorrelated with schizophrenia; negatively correlated with depression & anxiety/fear in general (interestingly, positively correlated with Neuroticism, see “Psychopathy and Personality” in the Handbook); positively correlated with substance abuse of various sorts, and with ADHD

In this chapter, we also reported that age, SES, and IQ are all inversely related to antisocial behavior. The older an individual is (after the age of 20 years), the higher their SES, and the higher their IQ, the less likely they are to engage in antisocial behavior. Moreover, we also reported that all of these variables are inversely associated with the antisocial behavior (Factor 2) component of psychopathy. However, it was interesting to note that none of these variables are associated with the emotional dysfunction (Factor 1) component of psychopathy…Much antisocial behavior shown by individuals with psychopathy is instrumental in nature - it has the goal of gaining another’s money, sexual favors, or “respect” (Cornell et al., 1996; Williamson et al., 1987). Individuals can attempt to achieve these goals through a variety of means. Having a higher SES (or for that matter intelligence) enables a wider choice of available routes for achieving these goals than having a lower SES (or intelligence). We suggest that a reason for the inverse relationship between SES and IQ with the antisocial behavior component of psychopathy is that lower SES/IQ limits the behavioral options available so that antisocial behavior appears a useful route to the goal. A healthy individual of limited SES/IQ may also have a narrow range of behavioral options but will exclude antisocial behavior because of aversion to this behavior formed during socialization (see chapter 8). In contrast, individuals with psychopathy may entertain the antisocial option because they do not find the required antisocial behavior aversive…In other words, we anticipate that there are individuals of higher SES who do not present with the full psychopathic syndrome even though their emotional dysfunction is of an equivalent degree to other individuals who present with both the emotional and behavioral components of the disorder.

  • Cornell D. G., Warren J., Hawk G., Stafford E., Oram G., Pine D. (1996). Psychopathy in instrumental and reactive violent offenders. Journal of Consulting and Clinical Psychology, 64, 783-790
  • Williamson S., Hare R. D., Wong S. (1987). Violence: criminal psychopaths and their victims. Canadian Journal of Behavioral Science, 19, 454-462

One extinction task that has been used with individuals with psychopathy is a card playing task originally developed by Joe Newman and colleagues (Newman et al., 1987). In this task, the participant has to decide whether to play a card. Initially, the participant’s choice to play is always reinforcing; if the participant plays the card he or she will win points or money. However, as the participant progresses through the pack of cards, the probability of reward decreases. Thus, initially ten out of ten cards are rewarded, then nine out of ten, then eight out of ten continuing on until zero out of ten cards are rewarded. The participant should stop playing the cards when playing means that more cards are associated with punishment rather than reward. That is, they should stop playing the cards when only four out of ten cards are associated with reward. Children with psychopathic tendencies and adult individuals with psychopathy have considerable difficulty with this task; they continue to play the cards even when they are being repeatedly punished and may end up losing all the points that they had gained (Fisher and Blair, 1998; Newman et al., 1987; O’Brien and Frick, 1996).

  • Fisher L., Blair R. J. R. (1998). Cognitive impairment and its relationship to psychopathic tendencies in children with emotional and behavioural difficulties. Journal of Abnormal Child Psychology, 26, 511-519
  • Newman J. P., Patterson C. M., Kosson D. S. (1987). Response perseveration in psychopaths. Journal of Abnormal Psychology, 96, 145-148
  • O’Brien B. S., Frick P. J. (1996). Reward dominance: associations with anxiety, conduct problems, and psychopathy in children. Journal of Abnormal Child Psychology, 24, 223-240

There are several ways in which people differentiate between moral and conventional transgressions. Thus, first of all, people generally judge moral transgressions to be more serious than conventional transgressions (Nucci, 1981; Smetana and Braeges, 1990; Turiel, 1983). Second, people give different reasons for justifying why moral and conventional transgressions are wrong. Thus, for moral transgressions, people refer to the distress of the victim (i.e., it is wrong to hit someone because it will hurt them), but for conventional transgressions, people refer to the social disorder that may ensue (i.e., it is wrong to talk in class because you are there to learn) (Smetana, 1993; Turiel, 1983). Third, and more importantly, modifying the rule conditions (for example, by an authority figure removing the prohibition against the act) only affects the permissibility of conventional transgressions. Thus, even if there is no rule prohibiting the action, participants generally judge moral transgressions as non-permissible (i.e., they still think it is wrong to hit another individual even if there is no rule against it). In contrast, if there is no rule prohibiting a conventional transgression, participants generally judge the act as permissible (i.e., they think it is OK to talk in class if there is no rule against it). While participants do not always make the moral/conventional distinction in their seriousness judgments, they do always make the moral/conventional distinction in their modifiability judgments. Thus, children at certain ages have been found to judge some conventional and moral transgressions as equally serious (Stoddart and Turiel, 1985; Turiel, 1983). However, they still identify the moral transgressions as less rule contingent and less under authority jurisdiction than the conventional transgressions.

  • Nucci L. P. (1981). Conceptions of personal issues: a domain distinct from moral or societal concepts. Child Development, 52, 114-121
  • Smetana J. G., Braeges J. L. (1990). The development of toddlers’ moral and conventional judgments. Merrill-Palmer Quarterly, 36, 329-346
  • Turiel E. (1983). The Development of Social Knowledge: Morality and convention. Cambridge: Cambridge University Press
  • Smetana J. G. (1993). “Understanding of social rules”. In M. Bennett (ed.), The Child as Psychologist: An introduction to the development of social cognition, pp. 111-141. New York: Harvester Wheatsheaf.
  • Stoddart T., Turiel E. (1985). Children’s concepts of cross-gender activities. Child Development, 56, 1241-1252

Children with psychopathic tendencies and adults with psychopathy have considerable difficulty with the moral/conventional distinction task (Blair, 1995, 1997; Blair et al., 1995a, 2001c). In addition, similar difficulties have been observed with more general populations of children presenting with antisocial behavior (Arsenio and Fleiss, 1996; Dunn and Hughes, 2001; Hughes and Dunn, 2000; Nucci and Herman, 1982). Children with psychopathic tendencies, adults with psychopathy, and other antisocial populations do generally regard moral transgressions as more serious than conventional transgressions. However, such populations are far less likely than comparison individuals to make reference to the victim of the transgression when justifying why moral transgressions are bad (Arsenio and Fleiss, 1996; Blair, 1995; Blair et al., 2001c; Dunn and Hughes, 2001; Hughes and Dunn, 2000). In addition, when the rules prohibiting the transgressions are removed, such populations are far less likely to make the distinction between moral and conventional transgressions that is seen in healthy individuals (Blair, 1995; Blair et al., 2001c; Nucci and Herman, 1982)…while it has been repeatedly shown that the use of empathy-inducing positive parenting strategies by caregivers decreases the probability of antisocial behavior in healthy developing children, it does not decrease the probability of antisocial behavior in children who present with the emotional dysfunction of psychopathy (Wootton et al., 1997).

  • Blair R. J. R. (1995). A cognitive developmental approach to morality: investigating the psychopath. Cognition, 57, 1-29
  • Blair R. J. R. (1997). Moral reasoning in the child with psychopathic tendencies. Personality and Individual Differences, 22, 731-739
  • Blair R. J. R., Jones L., Clark F., Smith M. (1995a). Is the psychopath “morally insane”? Personality and Individual Differences, 19, 741-752
  • Blair R. J. R., Monson J., Frederickson N. (2001c). Moral reasoning and conduct problems in children with emotional and behavioural difficulties. Personality and Individual Differences, 31, 799-811
  • Arsenio W. F., Fleiss K. (1996). Typical and behaviourally disruptive children’s understanding of the emotion consequences of socio-moral events. British Journal of Developmental Psychology, 14, 173-186
  • Dunn J., Hughes C. (2001). “I got some swords and you’re dead!”: violent fantasy, antisocial behavior, friendship, and moral sensibility in young children. Child Development, 72(2), 491-505
  • Hughes C., Dunn J. (2000). Hedonism or empathy? Hard-to-manage children’s moral awareness and links with cognitive and maternal characteristics. British Journal of Developmental Psychology, 18, 227-245
  • Nucci L. P., Herman S. (1982). Behavioral disordered children’s conceptions of moral, conventional, and personal issues. Journal of Abnormal Child Psychology, 10, 411-425
  • Wootton J. M., Frick P. J., Shelton K. K., Silverthorn P. (1997). Ineffective parenting and childhood conduct problems: the moderating role of callous - unemotional traits. Journal of Consulting and Clinical Psychology, 65, 292-300

Long section summary:

Data indicating that individuals with psychopathy present with relatively little or no impairment for functions known to require the integrity of the amygdala, such as the formation of stimulus-reward associations and aspects of social cognition, qualify the amygdala dysfunction position. They suggest that the genetic anomalies, which we assume are the fundamental causes of psychopathy, do not globally disrupt the functioning of the amygdala but rather have a more selective effect, perhaps by disrupting the functioning of specific neurotransmitter(s) involved in specific aspects of amygdala functioning. We suggest that the noradrenergic response to stress/threat stimuli may be disturbed in individuals with psychopathy.

More on the ADHD correlation:

ADHD is a conundrum because while there is high comorbidity of ADHD with psychopathic tendencies (Babinski et al., 1999; Barry et al., 2000; Colledge and Blair, 2001; Lynam, 1996), the neurocognitive impairments seen in children with ADHD are, to a large extent, not found in individuals with psychopathy. …Individuals with psychopathy show no impairment on classic measures of executive functioning such as the Wisconsin Card Sorting Task (LaPierre et al., 1995) or the ED-shift component of the ID/ED task (Mitchell et al., 2002). Individuals with ADHD show difficulty with both of these tasks (Pennington and Ozonoff, 1996; Williams et al., 2000). Individuals with psychopathy show no impairment, or even reduced interference (Newman et al., 1997), on Stroop, or Stroop-like, tasks (Blair et al., under revision; Smith et al., 1992). As described above, individuals with ADHD show striking difficulty with such tasks.

  • Babinski L. M., Hartsough C. S., Lambert N. M. (1999). Childhood conduct problems, hyperactivity-impulsivity, and inattention as predictors of adult criminal activity. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40, 347-355
  • Barry C. T., Frick P. J., DeShazo T. M., McCoy M. G., Ellis M., Loney B. R. (2000). The importance of callous-unemotional traits for extending the concept of psychopathy to children. Journal of Abnormal Psychology, 109(2), 335-340
  • Colledge E., Blair R. J. R. (2001). Relationship between attention-deficit-hyperactivity disorder and psychopathic tendencies in children. Personality and Individual Differences, 30, 1175-1187
  • Lynam D. R. (1996). Early identification of chronic offenders: who is the fledgling psychopath? Psychological Bulletin, 120(2), 209-224
  • LaPierre D., Braun C. M. J., Hodgins S. (1995). Ventral frontal deficits in psychopathy: neuropsychological test findings. Neuropsychologia, 33, 139-151
  • Mitchell D. G. V., Colledge E., Leonard A., Blair R. J. R. (2002). Risky decisions and response reversal: is there evidence of orbitofrontal cortex dysfunction in psychopathic individuals? Neuropsychologia, 40, 2013-2022
  • Pennington B. F., Ozonoff S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37, 51-87
  • Williams D., Stott C. M., Goodyer I. M., Sahakian B. J. (2000). Specific language impairment with or without hyperactivity: neuropsychological evidence for frontostriatal dysfunction. Developmental Medicine and Child Neurology, 42(6), 368-375
  • Newman J. P., Schmitt W. A., Voss W. D. (1997). The impact of motivationally neutral cues on psychopathic individuals: assessing the generality of the response modulation hypothesis. Journal of Abnormal Psychology, 106, 563-575
  • Blair K. S., Newman C., Mitchell D. G., Richell R. A., Leonard A., Morton J., Blair R. J. R. (under revision). Differentiating among prefrontal substrates in psychopathy: neuropsychological test findings
  • Smith S. S., Arnett P. A., Newman J. P. (1992). Neuropsychological differentiation of psychopathic and nonpsychopathic criminal offenders. Personality and Individual Differences, 13(11), 1233-1243

A possible overall picture:

No biologically based disorder other than psychopathy is associated with an increased risk of instrumental aggression Currently, there are no reasons to believe that there are any biologically-based disorders associated with a heightened risk of instrumental antisocial behavior other than psychopathy. There are other disorders associated with a heightened risk of instrumental antisocial behavior (e.g., adolescent-limited CD) but they are not biologically based. In chapter 8, we developed an account of psychopathy. In essence, this account suggests that genetic anomalies give rise to a disorder where there is reduced responsiveness of the amygdala to aversive stimuli in particular. This specific form of reduced emotional responsiveness interferes with socialization such that the individual is more likely to learn to use anti-social behavior to achieve goals.

Snakes in Suits: When Psychopaths Go To Work, Babiak & Hare 2006:

Psychopathy is a personality disorder described by the personality traits and behaviors that form the basis of this book. Psychopaths are without conscience and incapable of empathy, guilt, or loyalty to anyone but themselves. Sociopathy is not a formal psychiatric condition. It refers to patterns of attitudes and behaviors that are considered antisocial and criminal by society at large, but are seen as normal or necessary by the subculture or social environment in which they developed. Sociopaths may have a well-developed conscience and a normal capacity for empathy, guilt, and loyalty, but their sense of right and wrong is based on the norms and expectations of their subculture or group. Many criminals might be described as sociopaths. Antisocial personality disorder (APD) is a broad diagnostic category found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Antisocial and criminal behaviors play a major role in its definition and, in this sense, APD is similar to sociopathy. Some of those with APD are psychopaths, but many are not. The difference between psychopathy and antisocial personality disorder is that the former includes personality traits such as lack of empathy, grandiosity, and shallow emotion that are not necessary for a diagnosis of APD. APD is three or four times more common than psychopathy in the general population and in prisons. The prevalence of those we would describe as sociopathic is unknown but likely is considerably higher than that of APD.

Several recent twin studies provide convincing evidence that genetic factors play at least as important a role in the development of the core features of psychopathy as do environmental factors and forces. Researchers Blonigen, Carlson, Krueger & Patrick stated that the results of their study of 271 adult twin pairs provided “substantial evidence of genetic contributions to variance in the personality construct of psychopathy.” Subsequently, researchers Larrson, Andershed & Lichstenstien arrived at a similar conclusion in their study of 1090 adolescent twin pairs: “A genetic factor explains most of the variation in the psychopathic personality.” Viding, Blair, Moffitt & Plomin studied 3687 seven-year-old twin pairs and also concluded that “the core symptoms of psychopathy are strongly genetically determined.” They reported that the genetic contribution was highest when callous-unemotional traits were combined with antisocial behaviors.

Unfortunately, no group is more surprised to learn that they have been psychologically manipulated than those who believe they are smarter and stronger than others, no matter how true this may be. Narcissistic managers, in particular, tend to rise to management positions in organizations in disproportionately large numbers. Being particularly self-absorbed, they are known to use (and abuse) their subordinates and play up to their superiors to assure their own personal career success. (See pages 40-41 for similarities and differences between narcissists and psychopaths.) We have spoken with a number of narcissistic managers who also felt victimized by corporate cons: much to their own surprise-and not easy for them to admit- they were outclassed and outgunned. Additionally, and this really plays into the hands of the corporate con, individuals with strong personalities, such as narcissism, are far less likely than most to seek assistance, guidance, or even personal feedback until it is too late, making them attractive long-term targets.

PricewaterhouseCoopers (PWC) reported that in 2003, 37 percent of 3,600 companies in 50 countries had suffered from fraudulent acts, with an average company loss of more that $2 million. The actual average loss likely was much higher because of failures to detect or report frauds, or a tendency to write them off as a commercial loss. One quarter of the frauds were committed by senior managers and executives with a sophisticated understanding of the company’s internal controls and risk management procedures. In spite of the public outrage at the recent spate of high-profile scandals in the corporate world, things are not getting any better. In 2004, the percentage of companies in the PWC global survey that experienced fraud rose from 37 to 44 and then to 45 in 2005.

  • “Corporate Fraud in the Boardroom” Skalak, S., Nestler, C., & Bussmann, K. Global Economic Crime Survey, 2005. PricewaterhouseCoopers

In the journal Psychology, Crime, and Law, researchers Board and Fritzon administered a self-report personality inventory to a sample of British senior business managers and executives. They concluded that the prevalence of histrionic, narcissistic, and compulsive personality disorders was relatively high, and that many of the traits exhibited were consistent with psychopathy: superficial charm, insincerity, egocentricity, manipulativeness, grandiosity, lack of empathy, exploitativeness, independence, rigidity, stubbornness, and dictatorial tendencies.

  • Board, B. J., & Fritzon, K. Disordered personalities at work. Psychology, Crime and Law, 11(1), 17-32, 2005.

In our original research working with almost 200 high-potential executives, we found about 3.5 percent who fit the profile of the psychopath as measured on the PCL: SV (pages 26-28). [Unable to find a paper about this original research]

We now know that some organizations actively seek out and recruit individuals with at least a moderate dose of psychopathic features. Some executives have said to us, “Many of the traits you describe to us seem to be valued by our company. Why shouldn’t companies hire psychopaths to fill some jobs?” A proper, scientific answer is that more research is needed to determine the impact of various doses of psychopathic characteristics on the performance of different types of jobs. The “optimal” number and severity of such characteristics presumably is higher for some jobs (such as stock promoter, politician, law enforcement, used-car salespeople, mercenaries, and lawyers) than for others (such as social workers, teachers, nurses, and ministers). Until such research is done, we can safely say that those who believe that “psychopathy is good” clearly have not had much exposure to the real thing.

Are psychopaths particularly well suited for dangerous professions? David Cox, a psychology professor at Simon Fraser University, doesn’t think so. He studied British bomb-disposal operations in Northern Ireland, beginning his research with the expectation that because psychopaths are “cool under fire” and have a strong “need for excitement” they would excel at the job. But he found that the soldiers who performed the exacting and dangerous task of defusing or dismantling IRA bombs referred to psychopaths as “cowboys”-unreliable and impulsive individuals who lacked the perfectionism and attention to detail needed to stay alive on the job. Most were filtered out during training, and those who slipped through didn’t last long.

We analyzed the succession plans of a few hundred North American executives and noted that the similarities between the developmental issues for some managers identified as “high potentials” and psychopathic-like features were startling. Our list of questionable characteristics-dysfunctional behaviors, attitudes, and judgments-was refined to form the B-Scan, a research instrument for use by companies as part of their evaluation for succession planning. We obtained clear differences between a group of successful, high-performing executives and a group of convicted white-collar or economic criminals (that is, individuals who defrauded their companies and other innocent victims). In a follow-up investigation, we also found predictable differences between the successful high performers and corporate psychopaths. Research on the B-Scan continues.

“A Genetic Factor Explains Most of the Variation in the Psychopathic Personality”, Larsson et al 2006:

The authors used a self-report questionnaire (The Youth Psychopathic Traits Inventory) to study the importance of genetic and environmental influences on psychopathic personality traits in a sample of 1,090 monozygotic and dizygotic twin pairs, aged 16 -17 years. Results showed a strong genetic influence behind the higher order “psychopathic personality” factor, underpinned by the three psychopathic personality dimensions. Over and above the effects to the higher order factor, significant unique genetic influences were also found in the callous/unemotional and in the impulsive/irresponsible dimension, but not in the grandiose/manipulative dimension.

…there are only two published twin studies that have directly investigated the importance of genetic and environmental influences for psychopathic traits (Blonigen, Carlson, Krueger, & Patrick, 2003; Taylor, Loney, Bobadilla, Iacono, & McGue, 2003). One of these used a sample of adult male twins (Blonigen et al., 2003) and examined the genetic and environmental influence on psychopathic personality traits by using a self-report measure, the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996). Individual differences in all eight dimensions measured by the PPI were associated with genetic and nonshared environmental effects. Genetic effects explained 29%-56% of the variation of the respective dimensions of the PPI. Shared environmental effects were not found for any of the PPI facets (Blonigen et al., 2003). Another recent study on male adolescent twins (Taylor et al., 2003) used a self-report measure that taps the impulsive/antisocial behavior and callous/unemotional interpersonal style of the psychopathic personality constellation (Minnesota Temperament Inventory; Loney, Taylor, Butler, & Iacono, 2002). In this study, genetic effects accounted for approximately 40% of the variation in both the callous/unemotional and the impulsive/antisocial factors. Nonshared environmental effects explained all of the remaining variance, whereas the influences of shared environment seemed to be of no importance (Taylor el al., 2003). [emphasis added] …As would be expected, nonshared environmental influences were found [by us] to be significant in all of the analyses conducted. Nonshared environmental factors were shown to be important for explaining 37% of the variance in the latent psychopathic personality factor.

…The results from the present study suggest that shared environmental factors produce a negligible contribution to the variance in the psychopathic personality constellation. These results replicate those of recent twin studies examining self-reported psychopathic traits in adolescent (Taylor et al., 2003) and adult (Blonigen et al., 2003) twins in finding no evidence of shared environmental influences in psychopathic traits. The results are also consistent with evidence reported from many behavioral genetic studies of psychopathology (Bouchard & McGue, 2003) and personality (Bouchard & Loehlin, 2001; Loehlin, 1992; McGuffin & Thapar, 1992).

Handbook of Psychopathy, ed. Christopher Patrick 2005

For example, in her important study of mental illness in primitive societies, Murphy (1976) found that the Yupic-speaking Eskimos in northwest Alaska have a name, kunlangeta, for the

man who, for example, repeatedly lies and cheats and steals things and does not go hunting and, when the other men are out of the village, takes sexual advantage of many women-someone who does not pay attention to reprimands and who is always being brought to the elders for punishment. One Eskimo among the 499 on their island was called kunlangeta. When asked what would have happened to such a person traditionally, an Eskimo said that probably somebody would have pushed him off the ice when nobody else was looking. (p. 1026)

This is interesting since out of 500, the usual American base rates would predict not 1 but >10 psychopaths. Is this all due to the tribal and closely knit nature of more aboriginal societies, or could Eskimo society really have been selecting against psychopaths while big modern societies give scope for their talents & render them more evolutionarily fit? This may be unanswerable until the relevant genes are identified and samples of gene pools examined for the frequencies.

Considering the primary facets and citing Church (1994), Benning and colleagues (2003) identified the following as the strongest associations between the MPQ and FFM that are relevant to psychopathy: FFM (low) Agreeableness with the MPQ Aggression and Alienation facets of NEM, FFM Neuroticism with the MPQ Stress Reaction Facet of NEM, and FFM Conscientiousness with both the MPQ Control component of Constraint and the achievement facet of PEM. Thus, the Antagonism end of Agreeableness includes elements of MPQ NEM having less to do with stress reactivity, and Conscientiousness includes achievement or agentic elements of MPQ PEM.

“Treatment of Psychopathy: A Review of Empirical Findings”, Harris & Rice 2006; from Handbook of Psychopathy 2005:

The clinical literature has been quite pessimistic about the outcome of therapy for psychopaths. Hervey Cleckley, in his several editions of The Mask of Sanity (1941, 1982), described psychopaths as neither benefiting from treatment nor capable of forming the emotional bonds required for effective therapy. In contrast, some early studies claimed positive effects of psychotherapy (Beacher, 1962; Corsini, 1958; Rodgers, 1947; Rosow, 1955; Schmideberg, 1949; Showstack, 1956; Szurek, 1942; Thorne, 1959). However, all these were uncontrolled case reports. Reviewers before 1990 concluded, as had Cleckley, that there was no evidence for the efficacy of treatment with adult psychopaths (Hare, 1970; McCord, 1982).

  • Hare, R. D. (1970). Psychopathy: Theory and research. New York: Wiley.
  • McCord, J. (1982). Parental behavior in the cycle of aggression. Psychiatry, 51, 14-23

Based on these, Rice, Harris, and Cormier (1992) evaluated an intensive therapeutic community for mentally disordered offenders thought to be especially suitable for psychopaths. It operated for over a decade in a maximum security psychiatric hospital and drew worldwide attention for its novelty. The program was described at length by Barker and colleagues…The results of a follow-up conducted an average of 10.5 years after completion of treatment showed that, compared to no program (in most cases, untreated offenders went to prison), treatment was associated with lower violent recidivism for non-psychopaths but higher violent recidivism for psychopaths. Psychopaths showed poorer adjustment in terms of problem behaviors while in the program, even though they were just as likely as nonpsychopaths to achieve positions of trust and early recommendations for release. Why did the therapeutic community program have such different effects on the two offender groups? We speculated that both the psychopaths and nonpsychopaths who participated in the program learned more about the feelings of others, taking others’ perspective, using emotional language, behaving in socially skilled ways, and delaying gratification.

  • Rice, M. E., Harris, G. T., & Cormier, C. (1992). A follow-up of rapists assessed in a maximum security psychiatric facility. Journal of Interpersonal Violence, 5, 435-448

In another therapeutic community, Ogloff, Wong, and Greenwood (1990) reported on the behavior of psychopaths and nonpsychopaths defined by criteria outlined in an early version of the Psychopathy Checklist (Hare & Frazelle, 1985). Compared to nonpsychopaths, psychopaths showed less motivation, were discharged earlier (usually because of lack of motivation or security concerns), and showed less improvement. Similar results were reported for a therapeutic community in England’s Grendon prison in (Hobson, Shine, & Roberts, 2000), where poor adjustment to the program was likewise associated with higher PCL-R scores. A recent study of a therapeutic community for female substance abusers (Richards, Casey, & Lucente, 2003) reported that, although none of the offenders scored over 30 on the PCL-R, higher psychopathy scores were nevertheless associated with poorer treatment response indicated by failing to remain in the program, rule violations, avoiding urine tests, and sporadic attendance.

  • Ogloff, J., Wong, S., & Greenwood, A. (1990). Treating criminal psychopaths in a therapeutic community program. Behavioral Sciences and the Law, 8, 81-90
  • Hobson, J., Shine, J., & Roberts, R. (2000). How do psychopaths behave in a prison therapeutic community? Psychology, Crime and Law, 6, 139-154
  • Richards, H. J., Casey, J. O., & Lucente, S. W. (2003). Psychopathy and treatment response in incarcerated female substance abusers. Criminal Justice and Behavior, 30, 251-276

Besides therapeutic communities, cognitive-behavioral therapy is often recommended for psychopathic offenders. Andrews and Bonta (1994), Brown and Gutsch (1985), Serin and Kurychik (1994), and Wong and Hare (2005) all suggested that intensive cognitive-behavioral programs targeting “criminogenic needs” (i.e., personal characteristics correlated with recidivism) might be effective. For example, Wong and Hare recommended relapse prevention in combination with cognitive-behavioral programs. However, doubts as to the efficacy of this treatment with psychopaths arose from an evaluation of a cognitive-behavioral and relapse prevention program for sex offenders conducted by Seto and Barbaree (1999). High psychopathy offenders who were rated as having shown the most improvement (as measured by conduct during the treatment sessions, quality of homework, and therapists’ ratings of motivation and change) were more likely to reoffend than other participants, particularly in violent ways…It was highly structured and cognitive-behavioral, best matching the learning style of most offenders, including psychopaths. Moreover, psychopaths are high-risk offenders with many criminogenic needs (Zinger & Forth, 1998), and thus the program targeted deviant sexual preferences and antisocial attitudes (Barbaree, Peacock, Cortini, Marshall, & Seto, 1998). In view of these features, the results pertaining to psychopaths are especially notable.

  • Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen, F. T. (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology, 28, 369-404
  • Brown, H. J., & Gutsch, K. U. (1985). Cognitions associated with a delay of gratification task: A study with psychopaths and normal prisoners. Criminal Justice and Behavior, 12, 453-462
  • Serin, R. C., & Kuriychuk, M. (1994). Social and cognitive processing deficits in violent offenders: Implications for treatment. International Journal of Law and Psychiatry, 17, 431-441
  • Wong, S., & Hare, R. D. (2005). Guidelines for a psychopathy treatment program. Toronto, ON, Canada: Multi-Health Systems
  • Seto, M. C., & Barbaree, H. (1999). Psychopathy, treatment behavior, and sex offender recidivism. Journal of Interpersonal Violence, 14, 1235-1248
  • Zinger, I., & Forth, A. E. (1998). Psychopathy and Canadian criminal proceedings: The potential for human rights abuses. Canadian Journal of Criminology, 40, 237-276.
  • Barbaree, H. E., Peacock, E. J., Cortini, F., Marshall, W. L., & Seto, M. (1998). Ontario penitentiaries’ program. In W. L. Marshall, Y. M. Fernandez, S. M. Hudson, & T. Ward (Eds.), Sourcebook of treatment programs for sexual offenders. New York: Plenum Press

In another study, Hare, Clark, Grann, and Thornton (2000) evaluated cognitive-behavioral prison programs for psychopathic and non-psychopathic offenders. After short-term anger management and social skills training, 24-month reconviction rates for 278 treated and untreated offenders yielded an interaction between psychopathy and treatment outcome similar to that reported by Rice and colleagues (1992). Whereas the program had no demonstrable effect on non-psychopaths, treated offenders who scored high on Factor 1 of the PCL-R had significantly higher rates of recidivism than high-scoring but untreated offenders.

  • Hare, R. D., Clark, D., Grann, M., & Thornton, D. (2000). Psychopathy and the predictive validity of the PCL-R: An international perspective. Behavioral Sciences and the Law, 18, 623-645

How can we summarize these “controlled” studies of treatment outcome? We note that only one study (Rice et al., 1992) used the PCL-R, which is the contemporary standard (and most empirically valid) measure of psychopathy. Only two employed objective measures of criminal recidivism (Craft et al., 1964; Rice et al., 1992). Interestingly, our interpretation of both of these is that the treated group exhibited higher rates of recidivism than the control group. Our reading of the “controlled” studies in the Salekin meta-analysis is that there is absolutely no basis for optimism regarding treatment to reduce the risk of criminal or violent recidivism. Other problematic aspects of the meta-analysis cast further doubt on the author’s optimistic conclusion. As mentioned earlier, most studies in the meta-analysis relied on therapists’ ratings to measure outcome [!]. We consider this inadequate, especially for psychopaths. Note that Seto and Barbaree (1999) examined the recidivism of sex offenders as a function of psychopathy and progress in treatment, with progress assessed via eight structured therapist ratings. Based on these ratings, which showed good interrater agreement and were undoubtedly more reliable than unstructured impressions of therapeutic progress, those offenders with better than average progress were more likely to recidivate violently, and this was especially true for psychopaths. In our opinion, therapists’ impressions of clinical progress cannot be defended as an index of treatment effectiveness for offenders, especially psychopaths. Independently measured criminal conduct must be at least part of the outcome for an evaluation of treatment for psychopaths. This requirement eliminates all but a handful of the studies in the Salekin meta-analysis.

The later Handbook paper, “Risk for Criminal Recidivism: The Role of Psychopathy” (Douglas et al), also has useful critical comments on meta-analyses including the Salekin meta-analysis.


We believe there is no evidence that any treatments yet applied to psychopaths have been shown to be effective in reducing violence or crime. In fact, some treatments that are effective for other offenders are actually harmful for psychopaths in that they appear to promote recidivism. We believe that the reason for these findings is that psychopaths are fundamentally different from other offenders and that there is nothing “wrong” with them in the manner of a deficit or impairment that therapy can “fix.” Instead, they exhibit an evolutionarily viable life strategy that involves lying, cheating, and manipulating others.

The evolutionary hypothesis of psychopathy is striking (eg. it’s partially hereditable; or, sex offenders who target post-pubertal women have the highest PCL-R scores compared to any other subdivision of sex offenders), but not immediately relevant. It’s discussed a little skeptically in the chapter “Theoretical and Empirical Foundations” in the Handbook.

“Psychopathy and Personality”, Lynam & Derefinko, Handbook:

In summary, effect sizes for N came from FFM N, Eysenck’s N, and MPQ stress reaction. Effect sizes for E came from FFM E, Eysenck’s E, and the average of MPQ well-being and social closeness. Effect sizes for A came from FFM A, Psychoticism (reversed), and the average of MPQ aggression (reversed) and social potency (reversed). Effect sizes for C came from FFM C, Eysenck’s P (reversed), and Constraint. Results appear in Table 7.2. The weighted effect size for E is significantly different from zero but minuscule. N bears a small, positive relation to psychopathy with a weighted effect size of .14 and a 95% confidence interval ranging from .11 to .17. The effect for C is moderate to large and negative with weighted effect size of -.36 and a 95% confidence interval of -.38 to -.33. Finally, the relation between A and psychopathy is large and negative with a weighted average effect size of -.47 and a 95% confidence interval ranging from -.49 to -.44.

Based on these descriptions, the psychopathic individual is interpersonally antagonistic (low A). At the facet level, he is suspicious (low in trust), deceptive (low in straightforwardness), exploitive, aggressive, arrogant, and tough-minded. This individual has trouble controlling his impulses and endorses nontraditional values and standards (low C). Running somewhat counter to Cleckley’s original description is a tendency for the psychopathic individual to experience negative emotions (e.g., anger and cravingsrelated distress), although this relation is weaker than the relations to A and C. There is little evidence that the psychopathic individual is high or low in Extraversion.

…Less consistent were the results for Neuroticism (N) and Extraversion (E), perhaps due to facets of these dimensions relating differentially to psychopathy. For example, expert ratings and the PCL-R translation both suggest that the psychopathic individual can be described as high in some elements of N (i.e., angry hostility and impulsiveness/urgency) but low in others (i.e., self-consciousness). These distinctions may get lost when one moves to the domain or higher-order factor level where N demonstrates a small, positive correlation with psychopathy in the meta-analyses. The case may be similar for E. Expert raters and the PCL-R translation agree that psychopathic individuals are low in some elements of E (i.e., warmth and positive emotions) but high in others (i.e., excitement seeking). Again, these distinctions are lost at the domain level where E demonstrates a small, negative relation with psychopathy.

“Psychopathy and DSM-IV Psychopathology”, Handbook:

The relationship of psychopathy to anxiety disorders has been controversial (Frick, Lilienfeld, Elllis, Loney, & Silverthorn, 1999; Schmitt & Newman, 1999). Cleckley (1941) included within his original criteria for psychopathy an “absence of ‘nervousness’ or psychoneurotic manifestations” (p. 206). Rather than be troubled by the presence of anxiety disorders it was suggested that “it is highly typical for [psychopaths] not only to escape the abnormal anxiety and tension . . . but also to show a relative immunity from such anxiety and worry as might be judged normal or appropriate” (Cleckley, 1941, p. 206). Miller and colleagues (2001) surveyed 15 psychopathy researchers, asking them to describe the prototypic psychopath in terms of the domains and facets of the FFM description of general personality functioning. Their description included very low levels of anxiousness, inconsistent with the PCL-R assessment of psychopathy but consistent with the earlier description of this disorder by Cleckley (1941). In stark contrast, it is stated in DSM-IV that “individuals with this disorder [APD] may also experience dysphoria, including complaints of tension, inability to tolerate boredom, and depressed mood” (American Psychiatric Association, 2000, p. 702). It is noted more specifically that “they may have associated anxiety disorders [and] depressive disorders” (American Psychiatric Association, 2000, p. 702). The suggestion in DSM-IV that APD is associated with anxiety disorders can be attributed in part to the confinement of many of the APD studies to clinical populations (Lilienfeld, 1994). Anxiousness is common among persons in treatment for mental disorders.

“Neuroanatomical Bases of Psychopathy”, Handbook; summary:

Initial, preliminary structural imaging research on psychopathic groups has so far indicated (1) enlargement of the corpus callosum (Raine, Lencz, et al., 2003), (2) volume reduction in the posterior hippocampus (Laakso et al., 2001), (3) an exaggerated right > left asymmetry to the anterior hippocampus (Raine et al., 2004), and (4) reduced prefrontal gray volume (Yang, Raine, Lencz, LaCasse, & Colletti, 2005). Nevertheless, these latter two findings are specific to “unsuccessful” psychopaths and are not found in “successful” psychopaths….From a theoretical standpoint, anatomical prefrontal impairments in psychopathic and antisocial populations could help explain the disinhibited, impulsive behavior of psychopaths and underpin the classic low arousal/fearlessness/conditioning theories of psychopathic behavior. Callosal structural abnormalities give rise to a “faulty wiring” hypothesis of psychopathy and in part account for social, autonomic, and emotional impairments observed in psychopaths. Hippocampal impairments may predispose to affect dysregulation and poor contextual fear conditioning in psychopaths, in part by disruption to prefrontal-hippocampal circuits. In this context, while research on single brain structures provides a starting point for understanding the neuroanatomical basis of psychopathy, future research needs to better understand impairments to more specific neural circuits which give rise to biobehavioral abnormalities which result in specific psychopathic symptoms. As such, the neuroanatomy of psychopathy is a research field in its infancy

“Understanding Psychopathy: The Cognitive Side”

Psychopathy has not traditionally been associated with cognitive dysfunction, at least with regard to intelligence, memory, and executive ability (e.g., Cleckley, 1982). Indeed, psychopaths are notorious for the contrast between their good explicit knowledge and their profound failures when put to the test of daily life. However, it is possible that the assumption of intact cognitive ability is based on an overly simplified model of cognitive and executive functions.

Thus, both behavioral and physiological investigations of psychopaths’ attentional functioning are largely consistent with rigid task-focused attention that is poorly modulated by secondary or contextual information. In addition, these studies suggest that psychopaths’ attentional insensitivity to secondary or contextual information may be exacerbated by left-hemisphere activation. The possible contribution of left-hemisphere activation suggests a potential refinement of psychopaths’ difficulty accommodating unattended contextual information. We return to this possibility in the discussion section.

Attempts to replicate Lykken’s (1957) finding have produced mixed results and have revealed that psychopaths’ passive avoidance deficits are context dependent. Schmauk (1970) used a modified version of Lykken’s task, and examined passive avoidance under conditions involving verbal punishment (“wrong”), tangible punishment (loss of 25 cents), or physical punishment (electric shocks). In the conditions involving verbal and physical punishment, low-anxious psychopaths displayed smaller skin conductance responses, poorer passive avoidance learning, and less awareness of the punishment contingencies than did nonincarcerated controls. However, the groups did not differ on any of these measures when the punishment contingency involved loss of money. Later studies by other researchers have found passive avoidance deficits even with loss of money (Newman & Kosson, 1986; Newman, Patterson, & Kosson, 1987; Siegel, 1978). Newman and colleagues (1990) argued that, unlike Schmauk (1970), each of the studies demonstrating poor passive avoidance under conditions of monetary loss also involved a competing reward contingency. They argued that a competing reward contingency is an important component of psychopaths’ poor passive avoidance.

..Newman and Kosson (1986) presented participants with two versions of a passive avoidance task…Psychopaths made more passive avoidance (commission) errors than controls in the version involving competing reward and punishment contingencies but performed comparably to controls in the punishment-only condition. Newman and Kosson concluded that psychopaths show poor passive avoidance only in the presence of competing reward contingencies…Arnett, Smith, and Newman (1997) provided further evidence that psychopaths show normal avoidance of explicit punishment contingencies. …As with psychopaths’ attentional and language-processing abnormalities, psychopaths’ behavioral inhibition deficits reveal evidence of difficulty using information that occurs outside the primary focus of attention. Thus, poor accommodation of secondary or incidental information appears to be a consistent feature of psychopaths’ cognitive functioning. Although psychopaths’ hemispheric processing asymmetries have not been investigated within the domain of behavioral inhibition, it is worth noting that reward-seeking behaviors may differentially activate the left hemisphere (e.g., Davidson 1995; Miller & Tomarken, 2001; Sobotka, Davidson, & Senulis, 1992). The exacerbation of psychopaths’ disinhibition in the presence of a reward-seeking response set may therefore be consistent with Kosson’s (1996, 1998) findings of attentional dysfunction under left-hemisphere activating conditions.

The literature on psychopaths’ cognitive functioning is extensive and reveals a variety of consistent and compelling deficits …It is intriguing that psychopaths’ cognitive deficits do not fit established models of cognitive dysfunction, such as executive deficits or difficulty with sustained attention. Psychopaths appear to have adequate cognitive resources and capacity but difficulty maintaining an adaptive balance between top-down and bottom-up processing…Psychopaths’ deficits also indicate that context-specific failures in the appropriate, adaptive allocation of available resources can contribute to profound failures of self-regulation, despite the absence of traditional cognitive or executive deficits.

[Irrational, or just higher valuing of rewards/lower fearing of injury?]

“The”Successful" Psychopath: Adaptive and Subclinical Manifestations of Psychopathy in the General Population", Hall & Benning, Handbook

Consistent with prior research, unsuccessful psychopaths demonstrated reduced cardiovascular reactivity during a social stressor task, relative to controls. The nonconvicted psychopaths, however, exhibited a pattern of increased cardiovascular response during the stressor, which consisted of giving a brief speech about one’s faults. Relative to both comparison groups, these psychopaths also demonstrated a higher level of executive functioning, as measured by performance on the Wisconsin Card Sort Test (WCST; Heaton, Chelune, Talley, Kay, & Kurtis, 1993). Ishikawa and colleagues speculated that heightened autonomic reactivity to stress and relatively higher levels of executive functioning might act as protective factors for “successful” psychopaths, enabling them to avoid the riskiest of criminal activities that might result in arrest, conviction, and incarceration.

…To summarize, laboratory studies of psychopaths recruited from the community have demonstrated that these individuals tend to have higher arrest rates than the norm, but a slightly reduced rate of conviction relative to incarcerated psychopaths; they are psychometrically similar to incarcerated psychopaths in terms of self-reported personality (e.g., empathy, impulsivity, socialization, and MMPI profiles); and, like incarcerated psychopaths, they tend to demonstrate poor response modulation, careless motor behavior, and abnormal affective modulation of startle. Taken together, these findings point most notably to ways in which nonincarcerated psychopaths are phenotypically (and perhaps etiologically) similar to their incarcerated counterparts. Furthermore, these data suggest that at least a subset of nonincarcerated psychopaths manifest psychopathy at a reduced or subclinical level, insofar as their continued presence in the community is indicative of reduced severity of the process underlying their antisocial deviance. …Widom (1977) also noted that psychopaths from the community tend to come from higher socioeconomic backgrounds than incarcerated psychopaths.

“Psychopathy and Aggression”, Porter & Woodworth; Handbook

For example, in the Williamson and colleagues (1987) study, the majority of violent acts by psychopaths in the sample were not instrumental. This supports the idea that poor behavioral controls or impulsivity in psychopaths contributes to their violence (also see Dempster et al., 1996). Overall, these data established that psychopaths engage in both major forms of aggression, whereas violent nonpsychopaths are unlikely to engage in instrumental violence.

…A potential moderator of the relationship between psychopathy and violence is intelligence. That is, more intelligent psychopaths may be less inclined to use aggression because they can they can use their cognitive resources to devise nonviolent means (such as conning and manipulation) to get what they want. Less intelligent psychopaths may resort to violence to compensate for their inferior abilities to manipulate others through language. Heilbrun (1982) found that past violent offending in a sample of 168 male inmates was influenced by the interaction of intellectual level and psychopathy. Less intelligent psychopaths were more likely to have a history of impulsive violence than more intelligent psychopaths (and than less intelligent nonpsychopaths). Heilbrun (1985) reported that the most dangerous offenders in a sample of 225 offenders were those with the following characteristics: psychopathic, low IQ, social withdrawal, and history of violence.

While these early studies offered some evidence for intelligence as a moderator of psychopathy and violence, little research has addressed the issue in recent years, largely due to methodological obstacles. Specifically, the most intelligent psychopaths in society may succeed in corporate or political circles and/or use violence less frequently and thus may be less likely to wind up in prison. As such, they would be less likely to be studied by psychological researchers, whereas less intelligent psychopaths are available in disproportionate numbers for research.

Another potential issue in this area is that psychopaths with higher cognitive functioning may be as likely to commit violence as other psychopaths but be much less likely to be apprehended for such acts. Ishikawa and colleagues (2001) tested a community sample of 16 “unsuccessful” and 13 “successful” psychopaths (classified based on their PCL-R scores and whether they had received criminal convictions) on measures of autonomic stress reactivity and executive functioning (referring to the capacity for initiation, planning, abstraction, decision making). The two groups had engaged in a substantial and similar amount of self-reported criminal behavior, including violence. The results indicated that the successful psychopaths exhibited greater autonomic reactivity to emotional stressors and stronger executive functioning than unsuccessful psychopaths. This suggested that psychopaths who are less likely to be caught and convicted for their violent acts have the capacity for better planning and decision making than their unsuccessful counterparts.

“Toward the Future: Translating Basic Research into Prevention and Treatment Strategies”, Seto & Quinsey:

Meta-analytic studies demonstrating relatively few or no differences in the success of various psychotherapeutic approaches have stimulated research on the nonspecific factors that affect treatment outcome. There is good evidence that aspects of the therapeutic alliance are particularly important, with a recent meta-analysis of 79 studies finding a reliable, moderate relationship between measures of therapeutic alliance and outcome (Martin, Garske, & Davis, 2000). According to Martin and colleagues, the common elements across different definitions of therapeutic alliance are the collaborative nature of the therapeutic relationship, the affective bond between therapist and client, and the therapist’s and client’s agreement on treatment goals and tasks. Developing a therapeutic alliance with psychopathic clients could be quite challenging because of their defining characteristics and because of therapists’ reaction to noncompliance; disruptive behavior; the nature of psychopaths’ offenses; and concerns about possible exploitation, manipulation, and deception. One could imagine that there is a great deal of potential for therapist mistrust, suspicion, and more confrontational or hostile interactions with psychopathic clients (these therapist behaviors are sometimes referred to as countertransference in the clinical literature). Consistent with this hypothesis, Taft, Murphy, Musser, and Remington (2004) found that self-reported psychopathic characteristics were significantly and negatively associated with therapeutic alliance in a sample of men in treatment for partner abuse. Psychopathic characteristics were also negatively associated with motivation for change, and motivation for change mediated the relationship between psychopathic characteristics and therapeutic alliance.

Furthermore, although psychopaths have been described as affectively impoverished- for example, being less responsive to distress cues than nonpsychopaths (Blair, Jones, Clark, & Smith, 1997)-they do not appear to have deficits in the recognition of emotional states in others. Book, Quinsey, Cooper, and Langford (2004) studied the relationship between psychopathy and accuracy in perceiving the emotional meaning of facial expressions and body language in a sample of 59 male prison inmates and 60 men recruited from the community. Psychopathy was measured by the Self-Report Psychopathy Scale (Levenson, Kiehl, & Fitzpatrick, 1995) for all participants, and by the PCL-R for the inmates. The inmates’ PCL-R scores were not correlated with the number of errors in categorizing posed facial expressions and were positively but not significantly correlated with the inmates’ accuracy in rating emotional intensity of posed facial photographs. All participants rated the assertiveness of confederates from a brief, spontaneous videotaped social interaction between the confederate and one of the confederate’s friends. The Self-Report Psychopathy Scale was positively correlated with the accuracy of participants’ ratings of the friend’s level of assertiveness, as measured by both the confederate’s rating and the friend’s self-rating. In a companion study involving a subset of the same sample, Book, Quinsey, and Langford (2004) examined the relationship between psychopathy and the accuracy of posed facial expressions of emotion. Thirtyone inmates and 50 community volunteers agreed to be videotaped while attempting to mimic prototypical facial expressions (happy, sad, fearful, disgusted, and angry). PCL-R scores were positively associated with increased intensity of fear in the posed fearful faces, as measured by Ekman and Friesen’s (1978) Facial Action Coding System. Undergraduate students gave higher believability and intensity ratings to fearful faces posed by participants who had higher scores on the Primary Psychopathy subscale of the Self-Report Psychopathy Scale. A similar trend was observed for Factor 1 of the PCL-R. Taken together with other research showing that psychopathy is associated with deceptiveness (Seto, Khattar, Lalumière, & Quinsey, 1997), lack of response to distress cues (Blair et al., 1997), and an adequate theory of mind (Richell et al., 2003), these results indicate that psychopaths lack feelings for others but do understand their mental states; in other words, they know but they do not care. This does not seem to be much of a deficit if part of a socially manipulative and exploitative life history strategy.

…Although schizophrenia is a genetically caused brain disease, the most effective treatment discovered to date for its most severe manifestations is a rigorously implemented and very carefully planned behavioral program (Paul & Lentz, 1977). The thoroughness and integrity of implementation of this program seem to be the keys to its success. The implications for treatments of psychopathic offenders are clear (see also Harris & Rice, Chapter 28, this volume). Interventions to reduce recidivism among psychopathic offenders will need to be provided on an ongoing basis, although the intensity of service may vary over time with changing circumstances. These interventions will likely involve high staff-to-client ratios in order to provide sufficient supervision, to protect therapists from being deceived or manipulated, and to help them refrain from negative reactions to psychopaths that might interfere with intervention efficacy. Moreover, the interventions will focus on shaping behavior in desired directions, rather than more abstract concepts such as responsibility, empathy, and relapse prevention, with substantial attention devoted to program fidelity and a reliance on measures other than self-report. Given the evidence for psychopaths’ dominant response styles and differing response thresholds, increasing the salience and consistency of punishments would be important elements in these interventions. Other important intervention targets would include increasing delay of gratification and compliance with program rules and reducing aggression and associations with antisocial peers.