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Under a psychopathy ( Art word from Greek ψυχή , psyche , "soul" and πάθος , páthos , "suffering" are each ancient Greek pronunciation), a severe form of antisocial (antisocial) personality disorders (GSP) understood. The classification systems DSM-5 and ICD-10 do not include psychopathy as a diagnosis .


Today, psychopathy describes a severe personality disorder that is associated with the extensive or complete lack of empathy , social responsibility and conscience in those affected . Psychopaths are sometimes charming at first glance; they know how to create superficial relationships. In doing so, they can be very manipulative in order to achieve their goals. Psychopathy is often associated with antisocial behavior, so that in these cases the diagnosis of antisocial or antisocial personality disorder can often be made. However, psychopathy can sometimes occur as a comorbidity of a borderline or narcissistic personality disorder .


The first description of the modern term psychopathy is attributed to Hervey M. Cleckley , who in 1941 presented a differentiated description of the disorder in his book The Mask of Sanity . The further development was mainly driven by Robert D. Hare , who also developed the psychopathy checklist (PCL-R), the most widely used diagnostic method for the forensic field today . In the 14th edition of the textbook of psychiatry by Eugen Bleuler, revised by Manfred Bleuler , it says 1979 on page 557 “There are people who suffer due to the innate peculiarities of their character, their temperament, their instinctuality or their entire personality are disabled in their career and social integration and in some cases are an excruciating burden on their loved ones. These difficult people have been called 'psychopaths' for decades when their suffering seemed essentially similar to that of a sick person ”.

Differentiation from antisocial personality disorder

The concept of psychopathy includes specific personality traits and antisocial behaviors , whereas that of antisocial personality disorder only includes the latter. A proportion of 50 to 80% of inmates have an antisocial personality disorder, whereas less than 15% are classified as psychopathic.


For psychopathy it has been shown that different brain regions have a structural or functional deficit. The brain mass in the prefrontal and orbitofrontal cerebral cortex is reduced. This is u. a. associated with a poor understanding of social norms and a lack of a sense of guilt. A dysregulation of the amygdala function has also been described. It is believed that important social learning functions are impaired as a result. In addition, a hippocampus dysfunction could be proven. This is associated with inadequate anxiety conditioning and affect regulation. Other brain regions are also affected - presumably as a result of the defects described. There is speculation about incorrect regulation of the connection structures in the affected regions.

Elevated dopamine and low serotonin levels have been observed in psychopaths . This potentially leads to the disinhibition of aggressive impulses. Decreased cortisol levels were also observed. On the other hand, there are no clear data on a disturbance of the testosterone balance.

It is assumed that the dysfunctions and dysregulations already exist in early childhood.

Sub-dimensions and diagnostics

Diagnosis in the forensic area is usually carried out using the psychopathy checklist ( PCL-R ) by Robert D. Hare . This differentiates between two dimensions of psychopathy with a total of 20 criteria to be met:

Dimension 1: interpersonal-affective

(Core characteristics of the psychopathic personality, selfish and utilitarian - stable over a lifetime)

  • Cleverly eloquent blender with superficial charm
  • significantly increased self-esteem
  • pathological lying ( pseudology )
  • fraudulent manipulative behavior
  • Lack of remorse or guilt
  • superficial feelings
  • Cold feeling, lack of empathy
  • insufficient willingness and ability to take responsibility for one's own actions

Dimension 2: anti-social-deviant

(Conduct disorder, chronically unstable and antisocial lifestyle - tends to decrease with age)

Further points (not to be assigned to one of the sub-dimensions)

  • promiscuity
  • many short-term marriage-like relationships

These 20 criteria are rated with 0 (no value) , 1 (partial value ) or 2 (full value ) points , depending on their value. From 25 out of a total of 40 points to be achieved, a high psychopathy value is determined. From a PCL-R value of 30 points ( cutoff value), the diagnosis of psychopathy is made, whereby a cutoff value of 25 is recommended in German samples. It should be noted, however, that the selection of criteria in the Psychopathy Checklist (PCL-R) was developed by Robert D. Hare for diagnostics in the forensic area for psychopaths who have committed criminal offenses and for socially adapted psychopaths (see below), for whom dimension 2 is less pronounced or has appeared is not very suitable.

Hare estimates the proportion of psychopaths (in North America) at one in a hundred.

Psychopathy and crime

In one study, a selection of North American prison inmates were tested for psychopathy using the Hare checklist. Male prisoners achieved a mean value of 22.87 on a scale from 0 to 40, while women achieved a mean value of 12.10. Age and intelligence quotient did not show any significant differences.

Less than 5% of the population have high scores, but 15–20% of (US) prison inmates are responsible for 50% of all serious crimes.

The PCL-R value is used in forensic-psychiatric reports and has a high predictive power with regard to the likelihood of recidivism in violent crimes. This is 80% for psychopaths (PCL-R value ≥ 30), 62% for moderate psychopathy and 31% for non-psychopaths (PCL-R value <20).

Psychopathy in business and companies

The counterpart to criminal psychopaths is the group of highly functional "successful psychopaths". Although psychopathy has only a low prevalence in the general population, people with this personality disorder are overrepresented not only in prisons but also in higher hierarchical levels, about six times in management positions:

"[They] don't rob a bank, they become a board member."

- Robert D. Hare (founder of psychopathy research)

According to Reinhard Mohn , many problems in business can be traced back to people with mental health problems, especially narcissists and psychopaths. Psychopathy, narcissism and Machiavellian are part of the so-called Dark Triad .

"They are not violent [...] The damage they cause in our society is immense."

- Niels Birbaumer (neurobiologist)

“A normal person would [...] throw up if he had just messed up a billion. The psychopath goes home undaunted and doesn't think about it anymore. "

- Kevin Dutton (psychopathic researcher)

According to Dutton, the occupational fields with the highest proportions of psychopaths are: management , administration of justice (judge, judicial officer), media (television / radio), sales, surgery. Very few psychopaths, on the other hand, are found in social and nursing professions, as these are associated with little power and require an adequate handling of feelings.

Psychopaths have a tendency towards high-risk professions and prefer large organizations and clear hierarchies. According to Hare, human resource managers misinterpret psychopathic behaviors such as dominance and manipulation as leadership qualities. Because of their pathological lack of insight, they can only be mastered by eliminating them from the organizational structure. A fundamental prophylaxis would be to create “psychopath-proof incentive systems”.

There is also a gender effect: in a meta-analysis with 92 studies, higher psychopathy values ​​in men were positively correlated with leadership success, in women negatively. The authors suspect that assertiveness, dominance or reckless behavior are perceived as desirable leadership qualities in men, but less so in women. In addition, higher psychopathic scores increased the likelihood of taking on a management position in men, but this correlation was not found in women.


It is debated whether treatment for psychopaths makes sense. As a rule, it takes place in the penal system , in Germany in appropriate socio-therapeutic institutions . Most therapy programs today are behavioral and cognitive-behavioral . It has been reported that psychopaths respond differently to therapy. In some cases, an increased rate of recurrence after therapy has also been reported. In general, psychopaths are more difficult to treat than non-psychopathic offenders. From a neurobiological point of view, transcranial magnetic stimulation and pharmacological methods are suggested, although neither method has been further explored.

Extension of the term psychopathy

In recent popular science books , but also in scientific research, the term psychopathy is being expanded further. Examples of types of personalities are described who do not commit criminal offenses, in some cases even who are socially inconspicuous for a long time, are charismatic and have above-average professional success, but show manipulative and less empathic behaviors. A current revision of the concept of psychopathy can be traced back to the working group of the British psychologist James Blair , who is now researching at the NIMH in the USA . Blair understands the diagnosis psychopathy as a special and was preceded by an emotional disability form of behavioral disorder (conduct disorder) or antisocial personality disorder (antisocial personality disorder) , such as those listed in the DSM-IV and ICD-10. According to Blair, the most important distinguishing feature of psychopathy is the emphatically instrumental , purpose-oriented and goal-oriented character of the observed aggressiveness. In contrast, in the majority of cases of antisocial behavior, there is a predominantly reactive aggressiveness.

See also

Web links

Wiktionary: Psychopathy  - explanations of meanings, word origins, synonyms, translations

Individual evidence

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