New Beginnings Therapy

Current developments in assessment of psychopathy. Recycled article

This paper is proposing a succinct critical evaluation of existing research literature on psychopathology and, more specifically, is going to critically analyse definitional associations between psychopathy and criminality, biological basis for psychopathy, similarities and differences between psychopathic personality and antisocial personality disorder and current developments in assessment of psychopathy. This review is structured in three parts, each such part representing various degrees of understanding and associated research evidence for the aforementioned considerations. 

Definitions and classification of psychopathy are presented and linked to current research on criminality. This part is also going to attempt a clear response to the proposed statement that psychopaths are unable to prevent themselves from acting anti-socially, assess various features of psychopathy and its link to genetic predispositions of psychopaths and their anti-social behaviour. The second part of this paper is going to focus on biological basis for psychopathy, evaluate recent scientific findings and its implication for distinguishing between possible psychopathic subtypes such as primary and secondary psychopathy (Huss, 2014). The third and last section of this analysis is an evaluation of assessment of psychopathy and recent developments in the field. Such considerations are offered as an attempt to bring to the fore scientific evidence in order to inform initial stages of decision making in public policy regarding a proposed bill that would require pre-emptive indefinite hospitalization in a secure facility for psychopaths. A summary of findings is going to form the conclusion of this paper. The outcome is accompanied by a suggested acknowledgement that all findings need to be viewed alongside issues of ethics and methodology and not in isolation. All such analysis was developed as part of a reflective practice  between February 2018 and March 2019.

By way of introduction and in consideration of the first two statements proposed for analysis, a) psychopaths are criminal by definition and b) individuals with psychopathy are unable to prevent themselves from acting anti-socially, the nature of psychopathy and its classification with the psychological realms are necessary.

Cleckely (1941) offered one of the most used modern conception of psychopathy. Cleckley (1976) identified 16 different characteristics encompassed in a clinical profile of the psychopath. It included: a superficial charm and good intelligence, unreliability, lack of remorse and or shame, poor judgment and failure to learn from experience, incapacity for love and a general unresponsiveness in affective interpersonal relations (Huss, 2014). All such characteristics were identified during a trial in the UK during 2017/2018. Cleckley’s work on psychopathy influenced and inspired both early research on psychopathy and classification of behaviour in 2nd edition of the Diagnostic and Statistical Manual of Mental Disorders DSM- II (Skeem et al. 2011). Such influence has continued and considerations of Cleckley’s work is reflected in revised editions of DSM and its European counterpart classification, that of International Statistical Classification of Diseases and Related Health Problems – ICD. According to the revised Diagnostic and Statistical Manual of Mental Disorders (DSM-V; American Psychiatric Association, 2013), psychopathy can be construed as a clinical form of personality disorder and more specifically that of Antisocial Personality Disorder (Antisocial PD). In the tenth edition of International Statistical Classification of Diseases and Mental Health (ICD -10), published by World Health Organisation (WHO), psychopathy is closely linked to Dissocial Personality Disorder (Dissocial PD). In ICD-10 Dissocial PD is defined as a condition characterised by a disregard for social obligations, and callous unconcern for the feelings of others (F60.2, WHO. 1990). All such disregards for social obligation being well documented in various documents available to all agencies involved in the aforementioned Court Case on the applicant father. The cluster of features in Dissocial PD present a distinct and clear disparity between behaviour and the prevailing social norms, but more importantly suggest that behaviour cannot be easily altered by adverse experience including previous punishment. In this regard, it can be said that individuals diagnosed with Dissocial PD cannot prevent themselves from acting antisocial. Nevertheless, the criteria, albeit focused on affective deficits, cannot be found as representative of the overall behavioural and personality traits present in psychopathy (Ogloff, 2006) and in that sense, such understandings cannot be extended to psychopathy. The same observations are pertinent to the DSM – IV – TR criteria for antisocial personality disorder, although it is recognised that more emphasis is placed on common antisocial components of behaviour between PD and generalised psychopathy. In DSM – IV – TR, Antisocial Personality Disorder is described as: a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to confirm to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest.

2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit and pleasure.

3. Impulsivity and failure to plan ahead

4. Irritability and aggressiveness

5. Reckless disregard for safety of self or others

6. Consistent irresponsibility

7. Lack of remorse

DSM – IV states that Antisocial PD has also been referred to as psychopathy, sociopathy, or dissocial personality disorder.

Returning to psychopathology, like with a discriminatory act, the suggested collapse of terms has generated a reasonable amount of discussion at both theoretical level and amongst clinicians (Hare & Neumann, 2009), but more importantly has highlighted the cautiousness that needs to be employed when assessing statements such as psychopaths are by definition criminals. As it can be seen, psychopathy as a concept is highly problematic and incredibly difficult to disentangle from either antisocial behaviour and or affective deficits. Nevertheless, research on psychopathy has been seen as closely related to such constructs and equally different in that of including a distinct cluster of interpersonal, affective, lifestyle and antisocial traits and behaviours (Hare & Neumann, 2009). At an interpersonal level, individuals with psychopathy have been described as deceptive, dominant, superficial, grandiose and manipulative. Affectively, it is found that one important aspect of psychopathy concerns the inability to form and maintain strong attachment and/or relational bonds with others, coupled with a lack of empathy, guilt and remorse (Schimmenti et al, 2014).

Considering criteria present in both APD and Dissocial PD it is relatively clear as to why psychopathy as a clinical construct can be associated with both classifications of personality disorders and tied to a socially deviant lifestyle, however, such irresponsible and impulsive behaviour are seen as not necessarily criminal in nature (Hare & Neumann, 2013). Moreover, owed to such clinical understandings that psychopaths exhibit interpersonal emotional and cognitive deficits, various studies have further explored the biological basis for psychopathy in looking at both genetic factors and neurobiological evidence (Huss, 2014). What has been found is that a common genetic factor could account for significant variance across all four psychopathy factors (Hare and Neumann, 2009). Several twin studies comparing both identical and fraternal twins have yielded similar results, supporting the statement that psychopathy is a condition with strong genetic basis (Pozzulo et. al., 2013). A study by Bloningen, Carlson, Kruger, and Patrick (2003) with adult male twin pairs participants – 165 monozygotic (MZ) and 106 dizygotic (DZ) - and examining the etiology of psychopathy using a personality approach, revealed a substantial genetic influence. The authors’ findings were compatible with previously reported evidence regarding both antisocial and criminal behaviour (Bloningen at. Al 2003). In another study by Bloningen, Hicks, Kruger, Patrick and Iacono (2005), twin analyses suggested a significant genetic influence on distinct psychopathic traits such as fearless dominance and impulsive anitisociality. Furthermore, it was found that fearless dominance was associated with reduced genetic risk for internalising psychopathology, whereas impulsive antisociality was associated with increased genetic risk for externalising psychopathology (Bloningen et. al. 2005). The latter association being highly significant to subsequent accounts on psychopathy as a construct and further debates on how psychopathy at theoretical and measurable level is distinct from both antisocial behaviour and criminal behaviour. Hart et al (1990) administered a variety of neuropsychological tests to two sample of participants divided in low, medium and high psychopathy. Their findings suggest that there criminal psychopaths did not differ from other criminals in their performance. More importantly, the test scores of all participants, as well as global ratings of impairment, were not significantly different from those typically obtained with non-criminals of approximately similar age and education (Hart et. al. 1990). A recent study, Motzkin, et al. 2001 considers that various functional brain structures such as amygdala and the prefrontal cortex are relevant and involved in psychopathy and distinguishing between psychopathic subtypes, such as low anxious/ primary psychopathy and high anxious/ secondary psychopathy) , is crucial to clarifying the neural correlates of psychopathy.

Such studies, however, although can account for a significant genetic influence present across psychopathy domains do not reject the possibility that environmental factors can, do part-take and influence how these innate traits are expressed.

What is yet to be clarified is an understanding of the centrality of criminal lifestyle to the concept of psychopathy. From what has been attended to so far, a clear association between criminality and psychopathy is apparent, however, there is still need for clarification as to what type of association that is: whether criminality is highly correlated to psychopathy or is a core feature of a clinical profile of a psychopath. Skeem and Cooke (2010) pose a similar question in assessing the essence of psychopathy. They define criminal behaviour distinct from antisocial behaviour and inclusive of criminal behaviour that extends beyond markers of adult development including criminal behaviour in early development. They further argue that criminal behaviour lies within a conceptual domain strictly defined as violation of legal rules and what constitutes a law system whereas personality deviation is reflective of a violation of interpersonal norms, hence the two understandings should not be equated. Skeem and Cooke (2010) suggests that although it can be recognised that specific personality traits are inferred across various contexts and some traits of psychopathic personality are also identifiable as behaviour that defeats social order, it would be conceptually flowed if indicators of psychopathic traits are fixed on criminal acts. In making such conceptual and linear differences, Skeem and Cooke (2010) are overtly critical of the work of Hare and Newman (2005) that, according to Skeem and Cooke’s interpretation, are scholars that consider antisocial behaviour critical and central to psychopathy and where criminal behaviour is a prominent feature of antisocial behaviour (Skeem and Cooke, 2010). Moreover, Skeem and Cooke’s (2010) question the widely used Psychopathy Checklist - Revised (PCL –R) a measure of psychopathy devised by Robert Hare, in that of being highly problematic as it equates a structure of a construct with a model of psychopathy. Nevertheless, the PCL –R has been developed to measure the extent to which an individual meets the criteria for psychopathy in all four domains, and as such provides a score to which an individual presents characteristics consistent with psychopathy. The PCL-R is composed of 20 items and divided in two groups. Because the PCL-R is scored from 0 to 2, scores range from 0 to 40 and a score of 30 and greater is considered conservative score for psychopathy (Huss, 2014). Although the PCL-R cut-off score of 30 has proven essential in research and applications and understanding of psychopathy, some investigators have used other cut-offs scores for psychopathy: as score of 25 in some European studies (Hare and Neumann, 2009). It is generally agreed that PCL-R scores in the upper-range (30 and higher) are reflective across population sample of psychopathy in North-American male offenders as they do in female offenders and European male offenders and forensic psychiatric patients ( Hare and Neumann, 2009).

In response to Skeem and Cooke’s (2010) article, Hare and Neumann (2010) consider that Skeem and Cooke (2010) offered a simplistic understanding of psychopathy using a two factor model and in offering a critique of Hare and Neumann’s (2005) work in relation to the essence of psychopathy, they themselves failed to distinguish between the antisocial behaviour and criminal behaviour, using the two constructs interchangeably. Hare and Neumann (2010) state that, if indeed, academics or readers of Skeem and Cooke’s (2010) article are to correctly conceive their argument about the centrality of criminality to psychopathy, the reader should replace the word criminality with antisociality.

To conclude, what is fundamental to note is that associations between psychopathy and criminality and psychopathy and antisocial behaviour is extremely complex and by a careful consideration of such constructs, prominent experts and researchers in the field are further complicating current understandings in creating conceptual barriers. Collapsing terms such as criminal and antisocial behaviour or incorporating such terms (Skeem and Cooke, 2010) and considering antisociality central to psychopathy with scores continuously distributed, are clearly ongoing subjects for debate, however, what it becomes relatively clear is that the antisocial component of psychopathy is undisputable across various definitions and classifications, but such understanding is not extended to criminal behaviour or criminality, therefore it would be highly inaccurate to say that a definition of psychopathy is implicit a definition of criminality. 

Hare (2001) strongly suggests that psychopathy cannot conceptually or otherwise simply be equated with criminal behaviour, and its problematic theoretical ground rests with agreeing on exact criteria and conceptual boundaries of psychopathy (Huss, 2014). It is the conclusion of this paper that it is crucial for this type of research and knowledge base to be integrated and reflected upon in a larger framework, that at the very least includes ethics, cross-cultural issues and methodological matters.


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