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)
- Need for stimulation ( hunger for adventure ), constant feeling of boredom
- parasitic lifestyle
- Lack of realistic, long-term goals
- low behavior control
- Early behavior problems
- Juvenile delinquency
- Violation of probation conditions on parole
- Polytropic (varied) crime
Further points (not to be assigned to one of the sub-dimensions)
- 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."
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."
“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. "
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.
- Frank Thadeusz: Psychopathology: imbalance of the soul . In: Spiegel Online . January 7, 2011.
- Gabi Schlag, Dörte Wustrack: Unscrupulous and without compassion - Can psychopaths be treated? In: SWR2 knowledge. March 25.2013
- Stefan Gagstetter: Just normal madness. ( Memento from February 18, 2018 in the web archive archive.today ) Kevin Dutton sees psychopaths as role models. on: 3sat Kulturzeit , May 28, 2013.
- Birger Dulz, Peer Briken, Otto F. Kernberg, Udo Rauchfleisch: Handbook of Antisocial Personality Disorder. Schattauer Verlag, Stuttgart 2015, ISBN 3-7945-3063-2 . ( Excerpt as a reading sample , 72 pages, PDF 1.3 MB).
- Volker Faust: The unscrupulous psychopath: the most serious of all personality disorders. PSYCHIATRIE HEUTE, Psychosocial Health Working Group , November 6, 2008.
- Hare and Neumann: Psychopathy as a clinical and empirical construct. In: Annual review of clinical psychology. (2008) vol. 4, pp. 217-246.
- Nadine Defiebre, Denis Köhler: Successful psychopaths? On the connection between psychopathy and professional integrity. Publishing house for police science Prof. Dr. Clemens Lorei, Frankfurt 2012, ISBN 978-3-86676-238-1 .
- C. Kraus: References of the "Psychopathie Checklist-Revised" (PCL-R) to the DSM-III-R and ICD-10 classifications in sex offenders. In: Monthly for criminology and criminal law reform . Volume 82, No. 1, 1999, pp. 36-46.
- Birger Dulz, Peer Briken, Otto F. Kernberg, Udo Rauchfleisch: Handbook of Antisocial Personality Disorder. Schattauer Verlag (December 1, 2015), ISBN 3-7945-3063-2 .
- Jenessa Sprague, Shabnam Javdani, Naomi Sadeh, Joseph P. Newman, Edelyn Verona: Borderline Personality Disorder as a Female Phenotypic Expression of Psychopathy? Personal disord. 3 (2), Apr 2012, pp. 127-139. doi: 10.1037 / a0024134 , PMC 3323706 (free full text).
- H. Eisenbarth: Psychopathic personality in women - diagnostics and experimental findings in the forensic setting and in the world of work. Nervenarzt, March 2014, Volume 85, Issue 3, pp. 290-297. doi: 10.1007 / s00115-013-3902-9 .
- J. D. Miller, B. Gentile, L. Wilson, LR Pryor, WK Campbell: Searching for a vulnerable dark triad: comparing factor 2 psychopathy, vulnerable narcissism, and borderline personality disorder. J. Pers. 78 (5), Oct 2010, pp. 1529-1564. doi: 10.1111 / j.1467-6494.2010.00660.x .
- A. Nioche, C. Ducro, C. de Beaurepaire, L. Chudzik, R. Courtois, C. Réveillère: Psychopathy and associated personality disorders: searching for a particular effect of the borderline personality disorder? Encephale. 36 (3), Jun 2010, pp. 253-259. doi: 10.1016 / j.encep.2009.07.004 .
- Volker Faust: The unscrupulous psychopath. PSYCHIATRIE HEUTE, Psychosocial Health Working Group , November 6, 2008.
- W. Berner: Die Hare-Psychopathie-Checklist-Revised (PCL-R). Unpublished manuscript. 1994. (Original edition: RD Hare: The Hare Psychopathy Checklist-Revised [PCL-R]. Multi-Health Systems, Toronto, Ontario 1991.)
- Mairead Dolan, Birgit Völlm: Antisocial personality disorder and psychopathy in women: A literature review on the reliability and validity of assessment instruments. In: International Journal of Law and Psychiatry. 32, 2009, p. 2, doi: 10.1016 / j.ijlp.2008.11.002 .
- Hare and Neumann: Psychopathy as a clinical and empirical construct. In: Annual review of clinical psychology. (2008) vol. 4, pp. 217-246.
- Ogloff: Psychopathy / antisocial personality disorder conundrum. In: The Australian and New Zealand journal of psychiatry. (2006) vol. 40 (6-7), pp. 519-528.
- Glenn and Raine. The neurobiology of psychopathy. In: Psychiatr Clin North Am. (2008) vol. 31 (3), pp. 463-475, VII.
- Henning Ernst Müller (University of Regensburg): The PCL-R from Hare from a criminological and criminal procedural point of view. Professional Association of German Psychologists (BDP) eV - Forensic Psychology Section, November 17, 2012, accessed on April 27, 2015 (PDF; 1.4 MB), lecture on the 3rd day of forensic psychology.
- Robert D. Hare: Psychopathy, the PCL-R and Criminal Justice: Some New Findings and Current Issues . In: Canadian Psychology . tape 1 , no. 57 , 2016, p. 21-34 .
- Stefan Eidt: Comparison of the 2- and 3-factor model of the Psychopathy Checklist-Revised (PCL-R) in the recidivism prognosis of offenders. (PDF; 464 kB) Dissertation. 2007, accessed April 27, 2015 .
- Normative Data for the Psychopathy Checklist Revised in German-speaking countries. A meta-analysis. In: Criminal Justice and Behavior . tape 40 , no. 12 , 2013, p. 1397-1412 , doi : 10.1177 / 0093854813492519 .
- Hedwig Eisenbarth: PsychopathINNEN - more similarities than differences? . In: Saimeh, Nahlah (Ed.), Treating Evil (Pages 1–8), Eickelborn Series of Forensic Psychiatry, Volume 1, MWV Medizinisch-Wissenschaftliche Verlagsgesellschaft, Berlin 2014, ISBN 978-3-95466-057-5 .
- Spotting psychopaths at work. news.bbc.co.uk, December 1, 2004, accessed April 27, 2015 .
- Adolescent Psychopathy in Relation to Delinquent Behaviors, Conduct Disorder, and Personality Disorders. (PDF; 357 kB).
- Lydia Benecke: Psychopathinnen: The psychology of female evil. Lübbe Ehrenwirth Verlag, 2018, ISBN 978-3-431-03996-2 . Also: Lydia Benecke: Criminal women: That's why perpetrators are often played down. ( Memento from January 19, 2019 in the Internet Archive ) Brigitte 22/2018.
- Heiner Thorborg: Psychopaths in the executive floor - time bombs with ties. In: Der Spiegel. April 9, 2015, accessed April 27, 2015 .
- Kevin Dutton: Psychopaths - What To Learn From Saints, Lawyers, And Serial Killers . 1st edition. dtv, Munich 2013, ISBN 978-3-423-24975-1 (English: The Wisdom of Psychopaths - what saints, spies, and serial killers can teach us about success . 2012.).
- Paul Babiak, Robert D. Hare: Humans or Managers - Psychopaths at work . 1st edition. Hanser, Munich 2007, ISBN 978-3-446-40992-7 (English: Snakes in Suits - When Psychopaths Go to Work . New York 2006.).
- Carmen Kühn: Psychopaths in pinstripes . Ed .: Volker Lingnau , Albrecht Becker (= Controlling . Volume 17 ). 1st edition. Eul-Verlag, Lohmar – Köln 2012, ISBN 978-3-8441-0138-6 ( directory entry , table of contents - original title: Psychopaths in economic incentive systems - a nosological concept, dissertation . TU Kaiserslautern 2011.).
- Paul Babiak, Craig S. Neumann, Robert D. Hare: Corporate Psychopathy: Talking the Walk. Behavioral Sciences and the Law Behav. Sci. Law 28: 174-193 (2010). doi: 10.1002 / bsl.925 .
- Karen Landay, PD Harms, Marcus Credé: Shall We Serve the Dark Lords? A Meta-Analytic Review of Psychopathy and Leadership . In: Journal of Applied Psychology . tape 104 , no. 1 , 2019, p. 183-196 , doi : 10.1037 / apl0000357 .
- Doren and Yates: Effectiveness of sex offender treatment for psychopathic sexual offenders. In: International journal of offender therapy and comparative criminology. (2008) vol. 52 (2), pp. 234-245.
- Glenn and Raine: The neurobiology of psychopathy. In: Psychiatr Clin North Am. (2008) vol. 31 (3), pp. 463-475, VII.
- Robert D. Hare: Conscientiously. The psychopaths among us.
- Paul Babiak, Robert D. Hare: Humans or Managers: Psychopaths at work.
- Heiner Thorborg: Psychopaths in the executive floor - time bombs with ties. In: Der Spiegel. April 9, 2015, accessed April 27, 2015.
- J. Blair et al: The Psychopath - Emotion and the Brain. Blackwell Publishing, Malden, MA 2005, ISBN 0-631-23335-0 .
- AL Glenn, A. Raine: Psychopathy and instrumental aggression: Evolutionary, neurobiological, and legal perspectives. In: International Journal of Law and Psychiatry. Volume 32, 2009, pp. 253-258.
- Anne Campbell: Sex differences in direct aggression: What are the psychological mediators? In: Aggression and Violent Behavior. 11, 2006, p. 237, doi: 10.1016 / j.avb.2005.09.002 .