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It Isn't as Simple as It Seems: Understanding and Treating Psychopathy

Gillett and Huang (2013) claim that “research on the relationship between upbringing and the genesis of psychopathy and ASPD [antisocial personality disorder] . . . incorporates a local context and the artifacts within it as part of the psychopath’s cognitive machinery and invites us to examine the brain plus adaptive context (B + Ca) as the unit of cognitive adaptation” (3). However, we must distinguish ASPD, as defined by the DSM–IV (American Psychological Association 2000), and psychopathy, as defined by Hare’s checklist (Hare 1991). (Psychopathy is not a DSM-recognized disorder.) The symptomology and symptoms can overlap, but one is not a subset of the other (see Hare 1996). In particular, ASPD is defined primarily in terms of behaviors, but psychopathy is defined by personality traits as well. As a result, those with ASPD are identified by the sorts of trouble they get into, while it is entirely possible that a psychopath could go unnoticed and undetected for the entirety of his or her life. Most patients diagnosed with ASPD do not meet the criteria for psychopathy, while most psychopaths who come into contact with the criminal justice system do meet the criteria for ASPD. However, those who do not also do not typically meet ASPD criteria. The most important differentiator between psychopathy and ASPD is that psychopaths appear to be incapable of feeling empathy and processing many types of emotional stimuli, but those with ASPD exhibit neither deficit. (DSM–V, due out in May 2013, was supposed to fix the relative sloppiness of the ASPD diagnosis and unite these two syndromes under one umbrella. At last update, however, all proposed revisions to the classifications of personality disorders were voted down.) If we just focus on psychopathy, the developmental picture becomes considerably murky. While Blair (e.g., 2006) does argue for a developmental approach to understanding psychopathy, he is also very clear in his analysis that social and environmental factors do not shape psychopathy’s unfolding: “As yet, the environmental influences on the emergence of psychopathy remain unclear. The genetics studies. . . . [suggest] relatively little influence” (421). He further notes that “while positive parenting techniques are associated with reduced antisocial behavior levels in healthy children, they have no impact on the level of antisocial behavior expressed by children who present with the emotional dysfunction associated with psychopathy”