The Psychopath and Anti-Social Personality Disorder
For information purposes only. Do not substitute this information for any medical evaluation or opinion of a licensed professional. This may contain information which can be triggering for abuse victims.
The two faces of Dr. Jekyll and Mr. Hyde; Hannibal “the Cannibal” Lechter, and, of course, Norman Bates is the “Psycho” are Hollywood’s portraits of the psychopath. These familiar names are but a few of some of the most famous fictional horror characters in today’s culture. Almost everyone has heard of at least one of these characters. The mere mention of them conjures up images, in the public’s eye, of what a psychopath is. The stories, well told, have kept, at least a few of us, up at night at one time or another even though we know very well that these stories are fiction…or are they?
Hollywood can make some interesting and scary movies about “lunatics,” but as they say, “truth is stranger than fiction.” That is the case with regard to the true psychopath. Perhaps the reason we are terrified and are similarly intrigued by these characters is because we know that too often in the history of humanity there have been, and there are still, cold, unfeeling, unremorseful “monsters” preying on society. We are indeed so fascinated by their crimes that until we know them by name (Albert DeSalvo, Ted Kaczynski, and David Berkowitz), we have been known to create our own nicknames for them: The Boston Strangler, The Unabomber, and The Son of Sam, respectively. Still many others remain unidentified like Jack the Ripper and The Zodiac Killer.
What is more terrifying is that psychopathology is not a construct of Hollywood imaginations. It is a real personality disorder.
Cesare Lomborso - Italian Criminologist. B. 1835, d. 1909
Why study psychopathology?
What in the world is going on in the mind of the psychopath? Society has struggled between the ideas of trying to understand what makes them “tick” and wanting to “fry them.” Although it is a frightening and complex challenge, discovering the causes of this behavior is a task that must be undertaken. Consider the fact that it has been estimated there are between 10 and 500 serial killers active at any time in the United States alone. (Hepburn & Hinch).
Serial murder is far from being the only type of violence perpetuated by psychopaths. In fact, The FBI Uniform Crime Report (FBI-UCR) of 2001 listed the number of violent crimes in 2000 to be as high as 1.4 million. Still, over the past 20 years the number of violent crimes has decreased; in 2010 it was 1.2 million (according to FBI-UCR 2010). It is, therefore, imperative for the sake of reducing crimes and protecting society to determine the causes and the reasoning behind psychopathology.
Psychopathology is the most thoroughly researched personality disorder (Schwartz, S. 417). In an effort to define them, psychological professionals have renamed the disorder many times over. In the 19th century, psychopathology was called “moral insanity.” (S.L. Scott). Criminologists of the era were committed to the idea that criminality is genetic. Dr. Cesare Lomborso claimed the inheritance of this disorder could be recognized by defects in people’s physical appearance called stigmata: small skulls, asymmetrical faces, narrow foreheads, protruding ears, or prominent cheekbones. Lomborso was the authority on physiognomy, the false idea that character is written on one’s face. To say the least, it is prejudicial to conceive these notions especially since what is abnormal in one culture, is not in another. The belief that people are genetically inferior crosses a dangerous line as evidenced by the Nazis, who claimed to be “purifying” society with their extermination campaign (Schwartz. 426-427.).
The genocide witnessed during World War II forced psychologists to re-evaluate their theories. Instead of attributing the psychopathic behavior to genes, they took a serious look at social factors like discrimination, deprivation, and poor models. They decided to abandon the term “psychopath” altogether to avoid the link of the past and renamed the term “sociopath,” which reflected the social concerns related to the disorder (Schwartz. 426.). We, “the everyday folk,” are most familiar with the terms “psychopath” and “sociopath” despite the attempts to break away from the terms.
The Psychopath Stereotype Based on History
The most notorious psychopaths of medieval times were aristocrats, people with great wealth and power. A 15th century, French nobleman Gilles de Rais was heir to a great fortune. Following the execution of Joan of Arc, whom he fought alongside, he returned to his estate and began a nine-year reign of terror by prying on the children of local peasants. He did not kidnap his victims himself; instead he had his servants do it for him. When they were brought to his castle, the children, mostly boys, were tortured and dismembered. “The Bestial Baron” even violated their corpses. Executed in 1440, he has been widely regarded as the model for the fairy tale of Bluebeard.
Despite prominent examples of the past, modern-day psychopaths tend to be absolute nobodies. It explains why they are able to get away with gruesome acts for so long. Joel Rifkin, a Long Island landscape gardener slaughtered a number of prostitutes and stored their bodies in the suburban home he shared with his adoptive parents. No one could tell from looking at him that he would be capable of such atrocities (Schechter & Everitt. 12-13).
Scans Show Psychopaths Have Brain Abnormalities
Antisocial Personality Disorder
The latest classification is called Antisocial Personality Disorder (APD), a much milder term, but even the most violent and chilling criminals fall under this category. Without the intention of dismissing the seriousness of the crimes, one of the reasons given for this shift away from the use of the words “psychopath” or “sociopath” was that personality traits are difficult to measure reliably. It was easier to agree on behaviors that typify a disorder than on the reasons why they occur. While the diagnostic category is reliable, it lacks the well-established conceptions of psychopathy.
It is important to note, however, that most individuals diagnosed with Antisocial Personality Disorder are not psychopaths. Unfortunately, the classification resulted in an unforeseen result of reliance on a fixed set of behavioral indications that did not provide adequate coverage of what they were designed to measure (Hare). Simply put, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV), published by the American Psychiatric Association, tried to make the diagnosis as objective and non-prejudicial as possible in order to omit presumed etiologies.
Part of the problem in understanding, and perhaps treatment is that the DSM IV only requires that three out of the seven criteria be met in order to diagnose someone with APD. That is they only may meet less than half of the criteria. That determinant would have may people fall into this category including thieves, con-artist, corrupt government officials, even people who operate shady businesses. APD is considered a personality disorder, but it does not tell much a person’s temperament, just their habitual irresponsible behavior (Schwartz. 431.). The DSM IV also notes, “only when antisocial personality traits are inflexible, persistent, maladaptive and cause significant functional impairment or subjective distress do they constitute Antisocial Personality Disorder.”
Initially, these individuals can make a friendly and intelligent impression but they lack empathy and tend to be callous and cynical. They may have an inflated and arrogant self-appraisal and may be excessively opinionated. Individuals with APD are extremely irresponsible; and they are completely indifferent to their crimes. Unbelievably they may even blame the victims for being foolish or deserving of their fate. There is an irony to all of this. Some psychopathic traits like egocentricity, superficiality, and manipulation are being increasingly tolerated by society, perhaps even valued. This validation contributes to their ability to “camouflage” themselves within society for long periods of time (Hare.). It is not unusual, in fact it is very likely, that in addition to APD the individual will have associated disorders such as anxiety, depressive, substance-related, and somatization disorders. They have poor social relationships and erratic work histories because they are so unreliable. So while they may be extremely intelligent, their projects fail because they fail to plan ahead (Schwartz. 426).
Symptomology of Anti-Social Personality Disorder
What then is Antisocial Personality Disorder? The essential feature of APD is “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood,” according to the DSM IV. The DSM IV does note that the pattern has also been referred to as “psychopathy, sociopathy, or dissocial personality disorder.” According to the American Psychiatric Association, individuals must be at least 18 years old and have had a history of some symptoms of Conduct Disorder before age 15 (DSM IV. 702). Conduct disorder (CD) involves a repetitive and persistent pattern of behavior where the basic rights of others or other major age-appropriate societal norms or rules are violated. The symptoms included in the diagnosis of CD fall into four categories:
1. Aggression to people and animals (ex: bullying, initiating physical fights, use of a weapon that may cause serious physical harm, physical cruelty to people or animals, forcing someone into sexual activity);
2. Destruction of Property (ex: deliberate fire setting with intent to cause serious damage, deliberate destruction of property);
3. Deceitfulness or theft (ex: breaking and entering, conning, shoplifting, forgery);
4. Serious violations of rules (ex: staying out at night despite parental prohibitions, running away from home, school truancy).
CD is simply Antisocial Personality Disorder in children and adolescents; and it affects approximately two to six percent of school age youths (S.S. Luthar, et al. 249).
Diagnostic Criteria of Anti-Social Personality Disorder.
The complete diagnostic criterion for APD, according to the DSM IV, consists of four major areas:
1. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following:
a. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
b. Deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;
c. Impulsivity or failure to plan ahead;
d. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
e. Reckless disregard for safety of self or others
f. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
g. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
2. The individual is at least 18 years old
3. There is evidence of Conduct Disorder with onset before age 15 years
4. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.
Since the 2000 publication of the DSM-IV, there have been updates to the criteria of APD. Dr. Robert Hare, Ph.D., of the University of British Columbia, “defined a narrow set of criteria for recognizing the psychopathic antisocial personality. Such an individual would be characterized by antisocial behavior in adolescence and adulthood along with the following: superficiality, grandiosity, manipulation, lack of remorse, lack of empathy, impulsiveness, poor behavior control, and disavowal of responsibility.”
Are CD and ADHD precursors to anti-social personality disorder? Listen to the explanation by Rachel Klein, Ph.D., from NYU Langone Medical Center:
Children who live in abusive homes are at a greater risk of developing personality disorders.
The Risk Factors
The likelihood of developing APD in adult life is increased if the individual had an early onset of Conduct Disorder (before 10 years old) and Attention Deficit Hyperactivity Disorder; child abuse or neglect; unstable, inconsistent, or erratic parenting. APD affects about three percent of males and one percent of females. The highest prevalence is among men who are 25 to 44 years old (Schwartz. 433.). The problem with the broad range of diagnostic criteria is that it affects the determination of prevalence. Depending on the predominant characteristics of the populations being sampled, the estimate may vary from as little as three percent to as high as thirty percent of the population. Higher rates are found in substance abuse treatment settings, and prison or forensic settings (DSM IV).
The list of risk factors for the causes of violent behavior is broad. According to the American Academy of Child and Adolescent Psychiatry (AACAP), they are a “complex interaction” of physiological and sociological issues including:
1. Previous aggressive or violent behavior
2. Being the victim of physical abuse and/or sexual abuse
3. Exposure to violence in the home and/or community
4. Genetic (family heredity) factors
5. Exposure to violence in media (TV, movies, etc.)
6.. Use of drugs and/or alcohol
7. Presence of firearms in home
8. Combination of stressful family socioeconomic factors (poverty, severe depravation, marital breakup, single parenting, unemployment, loss of support from extended family)
9. Brain damage from head injury
Genetics: Considerable evidence pointing to genetics includes a high concordance for these traits among monozygotic twins than among other siblings. Research has also shown that adopted children resemble their antisocial biological parents more than their non-antisocial adoptive parents. Pedigree studies identified families with high rates of violent behavior among male members but pinpointing the precise manner in which antisocial behavior is inherited has proved to be unsuccessful. Evidence for brain trauma at birth in antisocial people is weak because most people who incur brain damage from birth trauma do not become antisocial.
One theory with a long history in psychology suggests that APD is the result of low emotional arousal, which people naturally try to escape. However, high-risk behaviors do not always lead to antisocial behavior (ex: hand gliding, mountain climbing). Sensation seeking is not a sufficient explanation for the development of APD. The argument about the effects of media on violence has been around for a long time. While there is evidence that the number of hours spent watching media violence is a predictor of aggression, it is not a very strong one. Consider Japan, which is famous for violent pornographic comics and cartoons; however, it suffers much less violence than other countries (Schwartz. 424-437.).
Environment of Children: Extensive research has shown that the child’s environment plays a critical role in the risk factor. It is impossible not to address these issues. Parents who provide an abusive and discordant environment are more likely to produce antisocial children but it is equally possible that personality traits can lead parents to provide an unstable, unhappy home life where they drink, fight, and abuse their children. It is difficult to separate environment from genetics in early childhood.
Child Abuse: Children who live in abusive, dysfunctional homes combined with exposure to antisocial models and a possible genetic tendency toward low arousal and compensatory sensation seeking are at a high risk of developing APD (Schwartz. 437.).
Albert DeSalvo, “The Boston Strangler,” had a father who brought prostitutes home with him and had sex with them in front of his children. He would savagely beat his wife when she complained. DeSalvo received vicious beatings with a lead pipe on a regular basis; and was sold into slavery. Charles Manson also came from an abusive home. His mother was an alcoholic and reportedly sold her son for a pitcher of beer. While she was in prison for armed robbery, an equally abusive uncle raised him. At one point he was placed in an institution where he was beaten routinely with a wooden paddle for bedwetting.
According to FBI findings 42 percent of serial killers suffered severe physical abuse as children, 43 percent were sexually molested, and an astonishing 74 percent were subjected to ongoing psychological torture. Brutality in childhood can create a murderous rage that is turned against humanity. Henry Lee Lucas, who committed a string of felonies, including murder, has been quoted as saying: “Killing someone is just like walking outdoors. If I wanted a victim, I’d just go and get one…I hated my life. I hated everybody. When I first grew up and can remember, I was dressed as a girl by my mother. And I stayed that way for two or three years. And after that I was treated like what I call “the dog of the family.” I was beaten. I was made to do things that no human bein’ would want to do.” (Schechter & Everitt. 292-294.).
While many psychopaths have portrayed their childhoods as horrific, it is possible that some stories may be exaggerated for sympathy. The opposite is also true; families that appear healthy may be very dysfunctional (Scott).
Symptomology during Childhood: Clearly, a major component in making a diagnosis of APD includes that the individual must have had the same problems from the time he or she was a child, so there is a somewhat of a return to the theory that one is born antisocial or has developed these tendencies early in life. Where human behavior is concerned, not many would disagree that much of it is developed during childhood. No one believes that a single gene is responsible for someone becoming a criminal. Modern psychologists believe that the interaction between genetics and the environment is responsible for all behaviors. (Schwartz. 431.).
The AACAP notes that children who have several risk factors and show the following behaviors should be carefully evaluated: intense anger, frequent loss of temper or blow-ups, extreme irritability, extreme impulsiveness, or becoming easily frustrated. We must realize that risk factors are simply just that. They are not absolute indicators. Many children come from abused homes and do not become psychotic or violent. Still no one has yet identified a single cause for the personality disorder (Morse and Wiley. 121).
Chronic Disorder and Long-Term Prognosis
The DSM IV states: “APD has a chronic course but may become less evident particularly by the fourth decade of life. Longitudinal studies show that conduct disorder can predict APD up to 30 years later (Zigler, 259.).
The long-term prognosis of children identified with CD consists of major characteristics that are likely to be evident in adulthood:
1. Psychiatric Status – Greater impairment including APD, alcohol and drug abuse, and isolated symptoms, greater history of psychiatric hospitalization.
2. Criminal Behavior – Higher rates of driving while intoxicated, criminal behavior, arrest records, and conviction, period of time incarcerated.
3. Occupational Adjustment – Less likely to be unemployed, shorter employment history, lower status jobs, more frequent change of jobs, lower wages, dependent on welfare, serve less often and less well in military services.
4. Educational Attainment – Higher rates of dropping out of school, lower attainment among those who remain in school.
5. Marital Status – higher divorce, remarriage, separation rates.
6. Social Participation – less contact with relatives, friends, and neighbors; little participation in organizations (ex: church).
7. Physical Health – Higher mortality rate, higher rate of hospitalization (physical and psychiatric) (Zigler. 261.).
When does the psychopathology stop?
So when does the psychopathic behavior stop? It stops when the individuals are caught or die. Society is not, and should not be willing to risk the opportunity to find out by releasing them. Several psychopaths admit to having no desire to reform themselves. Remember they have no remorse. The worst of them, the serial killers, live on the other side of our social boundaries, without reasoning capabilities (Scott.).
Treatment: The Library of the National Medical Society explains that treatment for APD in adults proves to be extremely difficult. Often times these patients will try to destroy or avoid the therapeutic relationship. Inpatient self-help groups in jails, not psychiatric hospitals, appear to be the most useful because the patient is not allowed to leave and enhanced peer interaction minimizes authority issues. Inpatient treatment must be carried out on a specialized unit. Specific deficits in the psychopath, which must be addressed are the inability to trust, to fantasize, to feel and to learn. The most successful inpatient programs involve long-term, strictly structured, hierarchical settings in which every aspect of the patient’s life affects, and are affected by, his progress. In addition, there should always be time for reflection. The use of psychotropic medication has not proved helpful (Long, Phillip, MD. (1995-2000.) “Antisocial Personality Disorder.” Internet Mental Health).
Prevention and Intervention: It is logical to deduce that prevention and intervention at an early age may be best, if not the only, means of gaining some kind of control over this incredibly destructive behavior. Since there is obviously no single cause, only the accumulation of risk factors, it appears the best approach is to minimize each risk factor. We, as a society, need to stop pointing fingers and placing blame. It is unproductive. Each member, group, and organization in society needs to become proactive. We need to accept responsibility to protect children and encourage healthy home atmospheres, simple words for a complex task. Most data has shown that societal issues are the major component in the risk factors for psychopathology: inadequate mental health services, unresponsive schools, child maltreatment, economic inequality, spiritual emptiness, and psychoactive substances (Garbarino). Although it may be impossible to completely eliminate the disorder, with a commitment from society we should be able to make tremendous gains in prevention.
American Association of Child and Adolescent Psychiatry. “Understanding Violent Behavior in Children and Adolescents.” Volume 55. Mar. 2001. http://www.aacap.org/publications/factsfam/behavior.htm 3/30/02.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th Edition. American Psychiatric Press. Washington, D.C. 2000.
Department of Justice, Federal Bureau of Investigations. “FBI Uniform Crime Report: United States Crime Rates 1960-2000.” Rothstein Catalog on Disaster Recovery. http://www.disastercenter.com/crime/uscrime.htm 3/20/02.
Department of Justice, Federal Bureau of Investigations. “The FBI Uniform Crime Report. 2010.” http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2010/crime-in-the-u.s.-2010/tables/10tbl01.xls 01/12/12.
Garbarino, James, PhD. “Violent Children: Where Do We Point the Finger of Blame:” Archives of Pediatrics & Adolescent Medicine. Volume 155, Number 1. January 2001. https://www.researchgate.net/publication/12153708_Violent_Children_Where_Do_We_Point_the_Finger_of_Blame. 6/3/2016.
Hare, Robert D., Ph.D. “Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion.” Psychiatric Times. Volume XIII, Issue 2. February 1996. Library of the National Medical Society.
Hepburn & Hinch. “Researching Serial Murder: Methodological and Definitional Problems.” Electronic Journal of Sociology. Volume 3 Number 2. 1998.
Luthar, S. S., et al. Developmental Psychopathology: Perspectives on adjustment, risk, and disorder. 1997.
Long, Phillip W., MD. Antisocial Personality Disorder, Internet Mental Health. 2002.
Morse, R. and Wiley, M. Ghosts from the Nursery. 1997.
Psychiatric News. “Antisocial Personality Disorder: When Is It Treatable?” Volume 39, Number 1. 25. (2004.). Jan. 2, 2004. http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=107089 1/12/12.
Schechter & Everitt. The A to Z Encyclopedia of Serial Killers. 1997.
Schwartz, Steven. Abnormal Psychology: A Discovery Approach. Mayfield Publishing Co., Mountain View, CA. 2000.
Scott, Shirley Lynn. “What Makes Serial Killers Tick.” The Crime Library Home Page. Courtroom Television Network LLC. 2001.
Zigler, Edward F. Developmental Psychopathology: Perspectives on adjustment, risk, and disorder. Cambridge University Press, New York, NY. 1997
By Liza Lugo, J.D.
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