Psychopathy was originally used to denote all mental irregularities. However, over time the term has gained popularity and began being used in a narrower manner. Today, Psychopathy is described as a personality disorder. Former research in the field has focused mainly on Juvenile psychopathy, and psychopathy of male criminals (Lynam & Gudonis, 2005). This research is extremely, common, important and helpful. With the help of this research, harmful individuals like Jeffery Dahmer and Ted Bundy can be properly incarcerated, and future crimes can be avoided. Cases like Dahmer and Bundy force us to focus on questions like: what is psychopathy, what causes it, and can it be prevented or treated? Therefore, the focus of this review is to determine where psychopathic tendencies generate from, how they are diagnosed, and if there is a way to properly treat them. For example, according to Johansson, Kerr, and Andershed (2005), there is an association between childhood high-impulsivity-attention problems and conduct problems and adult psychopathy. In order to understand the behaviors of criminals and their thinking; it is important to understand the neurological factors, behaviors, and events that may contribute to the development of a personality disorder. If the development of psychopathy was known it would create potential treatment plans, and hopefully decrease criminal tendencies among individuals in their future.
Keywords: PCL-R, juvenile, DSM-5, Conduct Disorder.
The Development, Diagnosis, and Treatment of a Psychopathic Individual
History of Psychopathy
The term psychopathy was first generated and used by multiple German psychologists in the 19th century. When the term was first created; it was used in a very broad spectrum. It was used extremely generally to describe individuals who were “psychologically damaged or had a psychological defect” no matter how small or insignificant the issue was. However, over the years the term has expanded a great amount because of individuals such as Hervey Cleckley and Robert Hare. Harvey Cleckley’s identification of a psychopath was a major contribution to the field. It gave the field the first real basis of classification, and a way to diagnose individuals. Hervey Cleckley wrote the book The Mask of Sanity. In this book he described his experiences dealing with psychopathic patients, who had not been involved in criminal activity. The features that Cleckley observed and experienced in these individuals included: “superficial charm and good intelligence, absence of delusions, irrational thinking, absence of nervousness, unreliability, untruthful- ness and insincerity. Lack of remorse and shame, antisocial behavior, poor judgment, failure to learn by experience, pathological egocentricity and incapacity for love, general poverty in major affective reactions, sex life impersonal, and failure to follow any plan” (Harris, Skilling, & Rice, 2001). Robert Hare generated another definition of the psychopath, by adding to the one that Cleckley described. While Cleckley focused on non-incarcerated individuals, Robert Hare discovered his findings while studying fear and arousal in incarcerated, psychopathic, criminal offenders. By studying male offenders who have been incarcerated or institutionalized, Robert Hare built upon the sixteen characteristics that Cleckley provided the field (Petty, 2013). He worked on expanding the list Cleckley created into twenty-two items which became known as the Psychopathy Checklist, and eventually into a 20 – item list known at the Psychopathy Checklist Revised, which is still used today (Lynam & Gudonis, 2005).
The PCL-R
Since around 1980 the Psychopathy Checklist-Revised, or the PCL-R, created by Robert Hare, has been used to diagnose adult individuals as a psychopath. The PCL-R is a questionnaire that contains 20 items. An examiner interviews an individual and bases the scores on their interaction, and institutional records (Lynam & Gudonis, 2005). The items are scored with numbers from zero to two. Zero represents “no features are shown”, one represents “maybe some features are shown in some aspects”, and two means “features are completely shown.” The twenty items on the list are: Glibness, grandiose sense of self-worth, need for stimulation, pathological lying, conning/manipulation, lack of remorse, shallow affect, lack of empathy, parasitic lifestyle, poor behavior control, promiscuous sexual behavior, early behavioral problems, lack of realistic goals, impulsivity, irresponsibility, lack of responsibility, short-term relationships, juvenile delinquency, revocation of conditional release, and criminal versatility (Buzina, 2012).
The Antisocial Process Screening Device
The PCL-R provides a stable structure in diagnosing adults, however modifications were made in order to diagnose children. Since many of the items on the PCL-R checklist apply only to adults, such as: need for stimulation, many short-term marital relations, lack of realistic long-term goals, and promiscuous sexual behavior, revision was needed when dealing with children. The Antisocial Process Screening Device was used to be the childhood version of the PCL-R. It measured all the items on the PCL-R that could be relevant to children. It is also a 20-item list, but it is different than the PCL-R because it is used as a self-assessment for children. It replaced the adult focused items with things such as: keeping the same friends, being concerned about school work, teasing others, bragging, and more (Lynam & Gudonis, 2005).
The Childhood Psychopathy Scale
Another way to diagnose children with psychopathy is the Childhood Psychopathy Scale. This scale operationalizes 13 of the 20 items from The Antisocial Process Screening Device into three-to eight-item scales. It measures glibness, untruthfulness, boredom, susceptibility, manipulation, lack of guilt, poverty of affect, callousness, parasitic lifestyle, behavioral dyscontrol, lack of planning, impulsiveness, unreliability, and failure to take responsibility. The Childhood Psychopathy Scale is a 55-item list with yes or no answers; it is filled out by the child and sometimes their parents (Bijttebier & Decoene, 2009). This way of measuring psychopathy is relatively reliable and valid; however, there can be instances where the children will mark off the easiest answers, or what they think is the most wanted answer. Therefore, by making this a self-report scale the children have the option to not always be honest which can tamper with the results and that can be a major issue with diagnosis.
The Hare Psychopathy Checklist: Youth Version
The Hare Psychopathy Checklist: Youth Version is also used as a replacement of the PCL-R. This is very closely related to the PCL-R for adults. All the same traits are measured, but the descriptions have been altered to be child appropriate. Similar to the PCL-R, there are 20 items, and they are scored from 0-2 by an examiner during an interview. The items on this list are geared towards things such as: peer, family, and school adjustment (Lynam & Gudonis, 2005). According to Frick (2009), adults with psychopathic traits often have long histories of antisocial behavior that extends into their childhood. This shows that diagnosing children early may provide more opportunity to prevent psychopathic individuals from becoming criminals.
Criminal Tendencies
Although psychopaths only make up about 20% of prison populations, and only 1% of the general population; they are considered a very dangerous group, and pose a serious threat, and financial cost to society. Psychopathy is considered one of the highest dispositional predictor of aggression, violence, and crime. Therefore, it projects large amounts of violence in forensic, psychiatric, community, collegiate, and youth populations (Reidy et al., 2015). According to Lynam and Gudonis (2005), the psychopathic offender is the most versatile and violent offender. According to Walsh (2013), many of the crimes that may be committed by the psychopathic offender include: robbery, domestic violence, assault, murder, weapons crimes, sex crimes other than indecent exposure and failure to register, kidnapping, and arson. They are more likely to participate in high-risk behaviors such as alcohol and drug abuse, and are more likely to participate in high-risk sexual practices. Edwards (2012) said,
“FBI reports in 1992 indicated that 44% of all murders of police officers were committed by psychopaths and other data suggest that the 20% of U.S. inmates who met criteria for psychopathy committed 50% of all serious crimes.”
Since these individuals are more likely to participate in high risk behaviors, and typically do not feel remorse or shame; psychopaths are at least five times more likely to recidivate violently than non- psychopathic offenders. They also commit twice as many violent crimes than non-psychopathic offenders (Reidy et al., 2015) and are twenty to twenty-five times more likely than non-psychopaths to be in prison (Kiehl & Hoffman, 2011). Since these particular individuals typically spend a lot of time in prison, which means trials, and lawyers; according to Edwards (2012), psychopathy costs the United States over $460 billion a year. With psychopaths being such a financial, and physical threat to society; it is important to properly diagnose, and treat these individuals at a young age.
Juvenile Psychopaths
Many adults who become violent criminals, and show psychopathic behaviors were once children who also had psychopathic tendencies. Children who exhibit psychopathic traits are at an increased risk for becoming violent adults and offenders (Reidy et al., 2015). Juvenile Psychopathy is a syndrome comprising a constellation of maladaptive interpersonal, affective, and behavioral traits in adolescents Although only 3 to 5% of adolescents become life-long, dangerous criminals; 60% of them can be classified as a Juvenile Psychopath (Farina et al., 2018). Juvenile Psychopathy is not located in the DSM-5, however, A Juvenile Psychopath will exhibit all of the symptoms and behaviors of Conduct Disorder listed in the Diagnostic and Statistical Manual of Mental Disorders IV (Edwards, 2012). According to Smith and Hung (2012), approximately 6% of children in the United States met the DSM-5 criteria for Conduct Disorder. Children who are diagnosed with Conduct Disorder may face many different outcomes in life, these include: prison, pregnancy, poor academic performance, and Antisocial Personality Disorder; which is closely linked with Psychopathy. These individuals are also at a much higher risk of becoming involved in life-long criminal activity.
It is very important to have a strong grasp on juvenile psychopathy because it can have serious implications in the court room. It is important not to use the label “juvenile psychopath” lightly. There is a large concern with juvenile psychopathy assessments. The primary concern is the potential for labeling, or assigning diagnostic terms that might stigmatize youth in a manner that moves decision-makers and jury members towards harsher sentencing during court trials. According to Boccaccini et al. (2008), The label ‘‘psychopath’’ has become a slang term used in popular media to characterize one as particularly evil and malicious. With that being said, labeling a child as a psychopath needs to be done very precisely, and is typically considered inappropriate; that is why there is no real DSM-5 diagnosis.
Causes
There are many things that may contribute to the onset of psychopathic tendencies and violent actions. Many of these are environmental, neurological, and social factors. such as interactions with peers and family members. Sometimes it is where an individual grows up, the exposure to alcohol and drugs, and more. Factors such as pre-existing conditions, and brain defects can also lead to psychopathic tendencies and eventually, criminal activity. During a study conducted in Russia, Antov and Lebed (2005), wrote:
“Many youngsters, even before they were placed in the institution, had suffered from a difficult life experience, severe stress: in the case of thirteen, it was the death of someone close to them; six mentioned the divorce of their parents. In ten cases one of the respondent’s closest relatives had been or remained incarcerated; twelve families included alcoholics, and four families included drug abusers. Nine respondents mentioned outbursts of violence, fights, and beatings. Eleven mentioned seriously ill relatives.”
With this being said, the home, and family relations plays a large role in the way an individual will interact with the outside world. Individuals who come from stable, and more harmonious families are less likely to have negative interactions in the outside world; compared to individuals who come from destructive and unstable families. According to Edwards (2012), many youths who show psychopathic feathers have histories of severe traumatic experiences or ongoing experiences with trauma in their life. With this being said, children who ultimately grow up to be labeled as psychopaths or commit crimes, are victims of their own environment. This shows that in some cases, psychopathy can be prevented or at least helped and decreased in severity if caught at a young age. If children who experience trauma are helped and nurtured, maybe there Is a chance of avoiding greater consequences. For example, according to Salekin, Rosenbaum and Lee (2008), there is a decrease in psychopathy scores across time when there is an increase in school friendships, school competence, and social competence serving as protective factors.
Other studies have also proved that pre-existing conditions such as conduct disorder, and attention-deficit hyperactivity disorder in children have had a major impact on the development of psychopathy in adults. According to Smith and Hung (2005), three perspectives are considered when discussing the relation between CD, ADHD and psychopathy. These include Conduct Problem Mediation, the Independent Position, and lastly the Comorbid Subtype. After extensive research the Conduct Problem Mediation perspective had the highest impact on the development of psychopathy. This perspective states that ADHD has one main influence on subsequent criminality. It was that hyperactive children were at increased risk for developing conduct problems. This ultimately places these children at risk for later serious antisocial behavior; which can be associated with psychopathy. As talked about before, many children suffering from psychopathy will show signs of conduct disorder early in life, and sometimes show callous unemotional (CU) traits. Callous unemotional traits include: showing an extreme want for odd stimulating and sometimes dangerous activities. Since many children who exhibit psychopathic tendencies also show signs of CU and ADHD, it is important for individuals to be aware of their pre-existing conditions, and how to treat them or prevent them from increasing in severity.
Lastly, there are neurological aspects that may contribute to the development of a psychopath. Evidence found by Harris et al. (2018) proves that psychopathy is partially heritable and mediated by genes and neurotransmitters. The first observation of the brain resulting in a personality change was in the famous case of Phineas Gage in the 19th century. During this case, there was an injury to the front lobe that lead to personality change. He became aggressive, promiscuous, and impulsive. This famous study ultimately led to many others that documented neurological damage, associated with the prefrontal cortex, related to aggressive or psychopathic-like behavior. Since then, a lot of research has been done, and advancements have been made regarding the brain and psychopathy. There have been major differences found between the brain of a psychopath and the brain of a health individual. Major differences are found in the prefrontal cortex, temporal lobe, amygdala, and the hippocampus. Prefrontal damage is associated with bad decision making, aggression, and impulsivity. The amygdala and temporal lobe is associated with deviant stimulus-reinforcement associations and abnormal processing of emotions and social cues. Lastly, the hippocampus accounts for memory and emotions. Therefore, if it is damaged it can have a negative effect on an individual’s life (Santana, 2016).
There are many factors that may contribute to the development of a psychopath. It is important to understand why an individual acts the way they do; whether it is environmental, social, or physical. If the causes are not understood then the treatment is not going to be correct, and that is not only a harm to that individual, but to society as a whole since psychopathy is such a serious and dangerous issue.
Treatment
Psychopathy does not only pose a threat to the individuals who are suffering from it, but it also poses a major threat to the society that they are living in. Therefore, a greater effort needs to be made to treat these individuals. In order to successfully treat individuals suffering from psychopathy there needs to be a higher understanding of where their issues are generating from, once this is figured out, treatment plans can be implemented. However, because of psychopath’s lack of amygdala function they do not process punishment like other non-psychopathic individuals. This makes it extremely hard to punish, and ultimately treat individuals with this issue. For example, individuals with higher levels of psychopathic traits had lower responsive rates to punishment methods, and displayed less negative responses when compared to boys with low or no psychopathic traits (Reidy, et al., 2015). This shows why understanding the neurological aspects and causes of psychopathy is so important; by having an understanding of these factors there can be a more individualistic approach to treatment.
Although this population may be difficult to treat; it does not mean they shouldn’t receive help. Psychopathy is not what individuals always think it may be, and according to Lilenfeld and Arkowitz (2018), there are many myths surrounding the disorder. Many individuals believe that psychopathy is completely untreatable, however this is not the case. It is proven that adult psychopathic offenders are much harder to treat than children psychopaths. Therefore, if signs can be caught at a young age, children should be put in treatment programs as soon as possible. It has been found that focusing more on socio-economic factors and development during intervention sessions, rather than things like academic and intellectual development, has a greater success rate towards recovery. When working with children it is important to focus on desired social behaviors. Many programs for children focus on incentives for positive interpersonal functioning, behavioral control, and continuous participation in the treatment plans (Reidy, et al., 2015). When working with individuals of this personality disorder, a primary prevention strategy should be implemented that employs methods of positive reinforcement. Individuals need to be constantly reinsured, at a young age, that certain actions and thoughts are not necessarily socially appropriate, or just. It is also extremely important to remember that in some cases than others, punishment tactics might do more harm than good, and it is important to know when to use them.
Future Research and Work
According to Edwards (2012), there is very little guidance available for practitioners who attempt to treat a child who is showing signs of psychopathy. This is definitely an issue, and is harmful to the psychopathic children, and society as whole. Further research needs to examine the main causes of psychopathy in children, and there needs to be a focus on how to find better ways to teach the field treatment techniques. Psychopaths can be malicious and dangerous, and there needs to be appropriate training and preparedness for that. According to Seagrave, and Grisso (2002), the techniques listed earlier used to diagnose children psychopaths, The Antisocial Process Screening Device, The Childhood Psychopathy Scale and The Hare Psychopathy Checklist: Youth Version are primarily being used for research at the moment. There is worry that these instruments are not yet to be used in the court room, and there must be further research regarding them before they can be fully utilized. Edwards (2012), also addresses the gaps in knowledge around the causes of psychopathy in juveniles. Although there is a lot of evidence around trauma, neurological and environmental aspects there is still a lack of understanding. More research around these topics would be helpful in understanding children, and there needs regarding treatment. Lastly, according to Kubak and Salekin (2009), there is a relation between anxiety and psychopathy in child offenders. However, it is uncertain what kind of method is best in researching the symptoms of the children. In some cases, self-reports have been more helpful, and in other cases parent and clinician reports have been more beneficial. With this being said, more research in this area could be extremely helpful to the field.
References
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