By Carrie Barron
A psychopathic person can have a profound impact on others. Determining if someone actually has this condition can be a challenge but matters for treatment and prognosis. Diagnosis can be confounding because some of the criteria listed in the Psychopathy Checklist (PCL-R, below) overlap with other similar conditions, have different meanings in different contexts and in isolation, may not be pathological. Narcissistic Personality Disorder and Antisocial Personality Disorder contain some of the same qualities. Charm can be a healthy aspect of a personality. Different people have different combinations of the traits in different quantities. It is not necessary to possess all the qualities or to engage in criminal behavior to have psychopathy. Context and history matter when inquiring about these traits. And psychopathy is not a formal diagnosis, unlike the other two disorders. Instead, psychopathy is assessed using scales like the PCL-R, which lists these traits of psychopathy:
- glib and superficial charm
- grandiose (exaggeratedly high) estimation of self
- need for stimulation
- pathological lying
- cunning and manipulativeness
- lack of remorse or guilt
- shallow affect (superficial emotional responsiveness)
- callousness and lack of empathy
- parasitic lifestyle
- poor behavioral controls
- sexual promiscuity
- early behavior problems
- lack of realistic long-term goals
- failure to accept responsibility for own actions
- many short-term marital relationships
- juvenile delinquency
- revocation of conditional release
- criminal versatility
While some of the qualities listed above are also part of other Personality Disorders m, the cardinal, distinguishing and perhaps most chilling attribute of psychopathy is a lack of remorse or guilt. No amount of pleading, admonishing, punishing, moral teaching or guilt-inducing exercises can cause these individuals to feel what they cannot or do not feel, or to truly regret or care about what they have done to damage another. Psychopathy is difficult to correct, though it might be corralled. When conscience, empathy, and perspective-taking– the ability to understand the inner life of another– are absent, loving exchange (the single greatest factor for health, happiness, good relations and longevity) suffer.
Psychopathy is a study in paradox and opposites. Because these individuals can be seductive, dynamic, mesmerizing, exciting and fun, they can elicit positive as well as perturbed feelings in other people. Being with a psychopathic person with these contradictory qualities can create confusion, excitement and edginess. Not knowing where one stands, what is real or whether someone is sincere while feeling very drawn to them at the same time, can be rattling. One can sense a callousness yet be pulled in by charm. Kind words may co-exist with cruel behaviors. Promises are easily dismissed. Psychopathic people can seem sympathetic and perform caring actions. They may drop in on your ailing mother, drive you to the airport, send you a gift or pay for your trip and be just, “the nicest guy.”
Sympathetic tears and grand altruistic actions may manifest but not be deeply or truly felt. Generosity can be motivated by a wish to people-please or manipulate to get access to opportunity. Performative compassion, as opposed to a true capacity for concern, can be a way to feed grandiosity or pump up an image as a pinnacle of virtue but be motivated by secondary goals from compliments to invitations to gifts.
A psychopathic person’s actions, whether they manifest in a beneficent or cutting manner, are not always consciously strategized. Forethought and planning can be absent and instead, a primitive, visceral instinct for personal advantage drives the behavior. Cunning and manipulative behaviors do also occur.
The psychopathic person can have a debilitating impact on others, covert or overt. Loved ones, friends, colleagues, children, neighbors and community members can benefit from insight, support, help with moving on and life choices. For example, stronger boundaries or all-out relationship cessation may be necessary for a loved one’s survival when the condition is severe and characterized by the more malevolent traits. An initial step is dealing with the mindboggling shock that what one saw was not what one got in a relationship partner, or that one’s beloved child is showing signs of callous and unemotional traits that typify psychopathy.
While the PCL-R list can help one gain insight and understanding, evaluation is best done by an expert. In addition to assessing context and history, clinicians know that the way the psychopathic person tells his or her story matters. An experienced interviewer can perceive nuances, gaps, complexities, confabulations, affects and distortions by inquiring in a creative and spontaneous as well as standard way. Sometimes it is necessary to try to glean information from loved ones as the psychopathic person can have a complex relationship with truth.
Carrie Barron, M.D., is director of Creativity for Resilience at Dell Medical School and an associate professor in the Department of Medical Education. She is also a board-certified psychiatrist, psychoanalyst, and Positive Psychology Coach.