Understanding Psychopathy

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Psychopathy both terrifies and fascinates us. People actively follow news of a serial killer and eat up stories similar to Jeffery Dahmer or Hannibal Lector. Yet, despite this morbid fascination, it seems almost beyond the realm of (normative) human understanding to comprehend the depths of this disorder. Although the symptoms of psychopathy (also known as antisocial personality disorder) are relatively easy to recognize and diagnose, its etiology remains enigmatic. For over a century theorists have battled with the concept of psychopathy and its roots; even with modern assessment techniques they have yet to reach a concrete conclusion. Because of the varied theories on what causes psychopathy, one can infer its multidimensionality. Undoubtedly there are different paths that lead to the same disorder; trait theory, neurobiology and developmental concerns are only the tip of this etiological iceberg.
Classified in the DSM-IV as antisocial personality disorder, the word psychopathy has permeated our vernacular to almost everyday usage. However, the disorder goes much further than the "psychopathic driver" that one so often encounters. Mostly men, individuals with this disorder seem to lack almost all human emotions and are able to commit the most violent of crimes without blinking. According to the DSM-IV, antisocial personality disorder is diagnosed by a pattern of affect and behavior that is inflexible, all pervasive, has its onset in adolescence or childhood (as conduct disorder before age 15) and deviates considerably from the social norm (as cited in Black, 1999). In addition to those criterions, one must have repeated disregard for the rights of others as well as general recklessness, impulsivity, deceitfulness, lack of remorse, and irresponsibility (as cited in Davison et al, 2004). They often are of normal intelligence and are able to manipulate others for their own gain through a superficial charm and deviousness (with a lack of remorse or empathy) (Claridge & Davis, 2003).
This lack of empathy allows psychopaths to commit violent and nefarious criminal acts without the slightest personal upset. In fact, for a disorder that only effects 1% of the general population, psychopaths commit a disproportionate amount of the crimes that occur; nearly 15% to 25% of the prison population has antisocial personality disorder (Kiehl et al, 2001). The various crimes that are committed by these individuals are often predatory and premeditated, with a sadistic quality that even Hollywood horror film makers could appreciate (Viding, 2004). Behavioral aspects such as these often decline after the individual turns twenty-seven, but one third of psychopaths remain criminally active throughout their lives (Black, 1999). Personality traits, however, remain constant and do not decline in severity with age.
Some theorists (Frick et al, 2003) attribute psychopathy and conduct disorder (in children and adolescents) to temperament and traits. Specifically, the trait of callous unemotionality contributes strongly to poor behavioral and emotional regulation. Because one of the diagnostic criteria of antisocial personality disorder is conduct disorder with onset before age fifteen, it is important to discuss the traits that embody such behavioral and emotional dysfunction. Conduct disorder in children is similar to psychopathy in adults; the same lack of empathy, moral poverty, and propensity to manipulate exists within these individuals (Frick et al, 2003). Their egotistic personality allows them to have no concern for the consequences others might suffer on their behalf. Salekin (2002) believes this callous unemotionality can be attributed to a temperament style of low behavioral inhibition. Once these children become older, these traits make them more likely to be socially deviant and to violate the rights of others. Also, this temperament style is associated with low emotional reactivity to adverse stimuli, suggesting a neurological basis for their fearlessness (Salekin, 2002).
The limbic system and the amygdala in particular play large roles in the possible neurological basis for psychopathy. Generally, psychopaths fail to understand or experience the emotional significance of affective stimuli the way ordinary people do (Kiehl et al, 2001). Dysfunctions in the limbic system and frontal cortex are found when psychopaths process affective material (Kiehl et al, 2001). Studies involving autonomic nervous system and skin conductance reveal that psychopaths respond less anxiously to fear eliciting stimuli (Davison et al, 2004). This suggests a basis for the fearlessness that leads psychopaths to be impulsive and recklessness, possibly due to damage in the cingulate cortex (Kiehl et al, 2001). They also have deficient processing of unconditioned stimuli (such as a distress cue) which implies psychopaths had a sub-optimally functioning amygdala; a poorly functioning amygdala could also be responsible for emotive and cognitive defects (Viding, 2004). Abnormalities exist within the limbic system and prefrontal cortex, which could be a reason for the impulsivity and lack of morality that permeates a psychopath (Kiehl et al, 2001). Although convincing, the neurological theories posed fail to reflect all the symptoms of psychopathy. However, this neurological basis could prove to augment individual vulnerabilities created by traits or development.
Although there are psychopaths that develop out of perfectly normal households with loving parents, many come out of broken homes or poor living conditions. Attachment theory suggests that inconsistent parenting practices lead to poor attachment profiles in young children; these weak attachment profiles are not significant enough to create a mental representation in order to guide future behavior (Salekin, 2002). Without a mental model of morality or interpersonal relationships, the psychopath has no connection to others besides himself. Inconsistent parenting and punishment are perhaps the most salient factors in the development of psychopathy. Varying degrees of punishment leads the child to assume the consequences to his actions are not something to be concerned about (Black, 1999). The absence of prosocial models can also have a large effect on the development of psychopathy (Millon, 2000).Often psychopaths stem from abusive families, and are exposed to violence and aggression at an early age (Salekin, 2002). Exposure to violence, aggression, and neglect could possibly lead the child to believe the world is not a good and safe place, thus creating a "survival of the fittest" attitude. With this attitude, it seems natural that they would develop a lack of empathy and morality altruism is weakness, and to trust is to be nave (Millon 2000).
Despite the shortcomings of the trait, neurobiological, and developmental theories of psychopathy, together they create a more unified picture of the disorder. The symptoms of psychopathy are fairly easy to recognize, but its roots are far more difficult to pin point. Psychologists have a good grasp on what the symptoms of psychopathy are, yet are still grappling with its etiology and the multidimensionality of this disorder. A comprehensive definition of psychopathy would involve the etiology of this disorder, but psychologists are still uncertain about its exact causes. The multi-causality of psychopathy still needs to be integrated to create a comprehensive definition.

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