Psychopathy Primer

Individuals with antisocial tendencies often present some of the most challenging cases for mental health practitioners. This is due in part to the fact that these individuals typically exhibit a lack of remorse or empathy and may be skilled in manipulating those around them.

Psychopathy, or antisocial personality disorder, is a mental disorder that is characterized by a lack of empathy and remorse, as well as a propensity for manipulation and deceit. People with this condition often present challenges for mental health professionals due to their manipulative tendencies and lack of concern for others.

It has been discussed that psychopathy exists on a spectrum, with extreme cases being classified as true psychopaths. For the purpose of this discussion, I will use the term “psychopath” more loosely to refer to the entire antisocial range.

People with psychopathic tendencies can exhibit a wide range of behaviors, from extremely violent and impulsive to charming and manipulative. Although there is no cure for psychopathy, it is possible to have a positive influence on people with antisocial tendencies. Psychopathy refers to a disorder related to a lack of emotion and attachment to others.

Some people exhibit more psychopathic tendencies than any other features of their personality and can be considered antisocial personalities. People who have met the criteria for a diagnosis of antisocial personality disorder may not meet the criteria for being considered either borderline or psychotic because of their ability to maintain a strong sense of self and to test reality gainfully.

Thus, the way they think and act demonstrates antisociality.

Some highly successful people display psychopathic characteristics.

Assuming that their ego strength is high enough, their ability to be ruthless and indifferent to others may make competitive achievements easier for them than for those who are capable of loyalty and thoughtfulness.

Practitioners often differentiate between passive but parasitic and aggressive/violent psychopaths. An example of an aggressive/violent psychopath can be the creator of a Ponzi scheme which family and friends see as kind until the scam is unveiled. Even though we are perhaps more caught off guard by the passive but parasitic psychopath, both are motivated by exploiting others. And so, the diagnosis of psychopathy has to do with internal motivation and not necessarily with criminal behavior.

How Psychopathy Develops

It is a well-known fact that infants differ in temperament from the time they are born. This has been established through scientific research, which has looked at factors such as activity level, aggression, reactivity, and consolability.

Studies of twins and adoptees have concluded that people who become antisocial may be innately more aggressive than others. However, in recent years, there has been an explosion of brain research which shows that our assumptions about what is constitutional and what is learned were naive: Genetic dispositions can be skewed by early experience, genes can be turned on or off, brain chemicals are altered by experience, and everything interacts. For example, in a longitudinal study, it was found that people with a variation in the expression of a gene that breaks down norepinephrine and related neurotransmitters are much more likely to develop violent and antisocial patterns when subjected to maltreatment.

Psychopaths have low levels of serotonin and low reactivity of the autonomic nervous system, both of which may be caused by early neglect, abuse, and maltreatment. The lack of serotonin can lead to sensation-seeking behavior, while the low reactivity of the autonomic nervous system can explain why we often see psychopaths not able to or lack the ability to learn from experience.

It has also been found that many psychopaths have anomalies in the brain circuitry that are responsible for language and affective processing because they have not learned about emotions in the same way that most people do when growing up. Psychopaths may use emotional speech as a way to control others instead of expressing their true feelings. People who are psychopathic have trouble regulating their emotions and need more extreme experiences to feel pleasure.

Psychopathic people have a hard time specifying their emotions because many acts instead of talking. They may have a sense of basic arousal but not the specific emotions that go along with it. When they do feel, it is usually either blind rage or manic exhilaration. One reason for this may be that they have a “massive affect block.” When treating psychopathic individuals, a connection between therapist and client is not automatically formed by reflecting a client’s presumed feelings.

Defense Mechanisms of Psychopaths

The main defense mechanisms used by psychopathic people are omnipotent control, projective identification, dissociation, and acting out. The need to exert power is more important to them than anything else. This defends against shame and, in brutal psychopaths, distracts others from seeing the perversions that often underlie their behavior. The psychopath’s lack of conscience is evidence of not only a defective superego but also a lack of primary attachments to other people. To the antisocial person, the value of others is their utility in allowing one to demonstrate clout.

Psychopathic people will shamelessly brag about their crimes if they think it will impress the listener with their power. They are deliberately trying to use others, whereas borderline and histrionic patients may unintentionally upset others and be seen as manipulative. However, their behaviors have significantly different sources, and they are actually trying to maintain relationships instead of using others.

Some psychopathic people “burn out” in middle age and may become more amenable to psychotherapy at that time. When hormone levels decrease at midlife, this may result in a decreased interest in activities that require physical exertion. However, this change may also be due to the loss of physical power that occurs during that period of life. When omnipotent defenses are unthwarted by limits, a person’s motivation to develop more mature adaptations is minimal. However, reality has a way of catching up with us, whatever our early advantages. Physical strength has declined, reaction time is down, health cannot be taken for granted, and the long-term costs of hard living have begun to appear. Death is no longer an abstraction. A mature person can sometimes better understand that they’re not in control of everything.

Psychopathic people may use projective identification because they have a reliance on primitive defenses and are unable to express emotions verbally. This means that the only way they can get other people to understand what they are feeling is to evoke that feeling in them. Psychopathic people often use dissociative defenses when confronting consequences for their actions. The range of possible actions is extremely broad; it can range from something trivial, like minimizing one’s role in some blunder, to something more serious, like total amnesia for a violent crime. They may also claim to have been emotionally dissociated or amnesic during some experience, especially during the perpetration of an offense, which makes it hard to tell whether the experience was, in fact, dissociated or whether words to this effect are a manipulative evasion of responsibility. Acting out is a typical sign of psychopathy. Antisocial persons are not only easily stimulated or upset but also lack the experience that would help them control their impulses and improve their self-esteem.

The Early Life History of Psychopaths

Many psychopaths have childhoods that are difficult and lacking in love and stability. This can lead to problems later in life, such as a need for power and control. Many psychopaths cannot acknowledge emotions because they associate them with weakness, which is likely due to their families of origin not helping them understand or express emotions. Recent thinking about psychopathy emphasizes the failure to develop attachments to and incorporation of others. Many adoptive parents have learned that children from neglected or abusive backgrounds can have attachment disorders that make them permanently unable to love.

One possible explanation for the development of psychopathy is that these individuals are innately aggressive and difficult to calm, comfort, and mirror. They need more intense, active, energetic, and engaging parenting than placid, easily consoled, dull youngsters. Without the love and pride of their caregivers, they may turn to self-esteem and personal power. When treating psychopathic individuals, therapists cannot expect to make an alliance by reflecting on the client’s presumed feelings.

Psychopaths in Therapy

Sociopaths often view their therapists as potential predators. This shapes the way they interact with them, as they may be charming or even hostile in an attempt to figure out the therapist’s “angle.” These interactions can be difficult for therapists to deal with, as they may find themselves feeling cold or even hateful toward their patients. However, it is important to understand that these reactions are normal and that sociopaths pose a real threat.

It is possible to help psychopathic people through therapy, although it is important to assess whether each individual is treatable. The most important thing in therapy with psychopaths is to be incorruptible and honest. The goal is to help the patient move toward seeing others as different subjects worthy of care. Even a small progress in this direction can prevent a lot of suffering.

The Mistaken Diagnosis of Psychopaths

There are certain personality types that can easily be mistaken for psychopaths when they display antisocial behavior. These include people who are paranoid, dissociative, or narcissistic. The behavior of people who are addicted can also mimic that of a psychopath. In addition, some people with hysterical personalities may be misdiagnosed as psychopaths.

Paranoid vs. Psychopath

There is a lot of overlap between predominantly psychopathic psychology and paranoid psychology. Both antisocial and paranoid types share much with the Machiavellian personality; all are highly concerned with issues of power but from different perspectives. People with essentially paranoid character structures have profound guilt, unlike psychopaths. This is something that must be taken into account when assessing which tendencies predominate in someone who has both paranoid and psychopathic features.

Dissociative vs. Psychopathic

There is a lot of overlap between psychopathic and dissociative conditions, which can make it difficult to determine which one a patient has. It is important to evaluate whether a patient is a psychopathic person who uses dissociative defenses or whether he or she has dissociative psychology with one or more antisocial or persecutory alter personalities. The prognosis for the former is not good, while many people with dissociative disorders respond favorably to therapy. When making this differential diagnosis, it is important to keep in mind that both psychopathic and dissociative people have a deep distrust of others.

Narcissistic vs. Psychopathic

There is a close connection between psychopathic and narcissistic conditions, with most people having both aspects. Both predominantly narcissistic and predominantly psychopathic people have a subjectively empty internal world and a dependence on external events to provide self-esteem. However, treatment considerations are quite different for the two groups. It is essential to differentiate with care between two types of people. A sympathetic mirroring will comfort a narcissistic person but will antagonize an antisocial person.

Addiction vs. Psychopathy

People with substance abuse disorders may exhibit manipulative and exploitative behavior because their addiction has become more important to them than human relationships. Although some addicted people may have a personality disorder, it is not possible to know for sure until the interviewer has obtained reliable information about their behavior prior to their addiction or until they have been in recovery for a considerable length of time.