Antisocial Personality Disorder Research Paper

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Antisocial personality disorder is arguably the most important of personality disorders, in terms of both impact on society and complexity of psychological and legal issues. The concept of the antisocial personality disorder is confused by the common usage of three overlapping terms: the criminal personality, the antisocial personality, and the psychopath (sociopath). The criminal personality is a sociological term, not a DSM category. As we will see, it includes a variety of different personalities who are involved in some way in criminal activity. Many different personality types function as criminals in our society; of these, the antisocial personality, or the related term “psychopath,” is only one specific psychological syndrome. Antisocial personalities apparently account for no more than about 30% of the overall prison population.

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I. Characteristics of the Criminal

II. Antisocial Personality Disorder–Psychopath Terminology

III. Characteristics of the Antisocial Personality (AP)

IV. Heritability of Psychopathy

V. Difficulties in Studying the Psychopath

VI. Assessment Measures with AP

VII. PCL-R-Generated Concepts

VIII. The Psychopath and the Major Theoretical Orientations

A. Psychodynamic Concepts

B. Learning/Behavioral Concepts

C. Cognitive Concepts

D. Existential Concepts

E. Biological Concepts

IX. Proposed “Common Path” for the Development of Psychopathy

A. Pre-existing Risk Factors

B. From Birth to School Age

C. School Age to Adolescence

D. Adolescence

E. Adulthood

X. Intervention Issues

A. The Issue of Antisocial Burnout

XI. Summary

XII. Bibliography

I. Characteristics of the Criminal

Several overall patterns characterize the criminal. Four principal characteristics of the criminal lifestyle are (1) irresponsibility, (2) self-indulgence, (3) interpersonal intrusiveness, and (4) social rule breaking. The young or “apprentice” criminal is typically motivated by peer influence, combined with stimulation-seeking, which gradually give way to more antisocial components as the criminal career develops. More specifically, the majority of offenses are caused by individuals aged 21 and younger, and approximately 80% of adult chronic offenders were chronic offenders before age 18. Criminals tend to be male, at about a 5:1 ratio, up to as high as 50:1 in some specific categories of aggressive crime. With the rise in feminism, we are increasingly closer to gender parity in “white-collar crime,” but the high ratio of males has persisted in aggressive crimes. As to the general causes of crime, both poor sociocultural conditions and heredity are major factors, while more specific factors are cold, rejecting, harsh, inadequate, and/or inconsistent parenting; a high level of stimulation-seeking; psychopathy; impulsivity; low intelligence, especially low verbal intelligence; mesomorphic body type; and a history of hyperactivity, handicap, and/or being abused as a child.

Psychodiagnostician Edwin Megargee and several colleagues have developed an ongoing research program that has generated an excellent typology of the criminal personality. Using data primarily from the MMPI, they differentiated 10 criminal types in one prison population. On the basis of behavioral observations, social history data, and other psychological tests, they obtained validation for this classification and subsequently extended its use to other prison populations. Most importantly from the perspective of good research design, researchers working independently of Megargee established the validity of the system in other prisons, and others have independently validated similar patterns. It is clear from this and other data that there is no single criminal type. Their empirically derived and applicable system is likely to remain the standard one for many years.

II. Antisocial Personality Disorder—Psychopath Terminology

The term antisocial personality reflects an evolution through a number of terms, the most widely known of which has undoubtedly been “psychopath.” In about 1800, Philippe Pinel coined the term Manie sans delire to reflect the fact that these individuals manifest extremely deviant behavior but show no evidence of delusions, hallucinations, or other cognitive disorders. While Pinel was certainly including several personality disorder categories other than the antisocial personality in his descriptions, James Prichard’s label of “moral insanity,” denoted in 1835, is a clear forerunner of the antisocial personality grouping. This general conceptualization grew in acceptance, and late in the 19th century the label psychopathic inferiority, introduced by Johann Koch, became the accepted term. Later variations included “psychopathic character,” “psychopathic personality,” and “psychopath.” Expositions by a number of individuals, particularly by Hervey Cleckley, brought the term into common usage.

Despite the foundation for the condition, the first (1952) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-I), the generally accepted “bible” of mental disorder classifications, muddied the issue by substituting the term “sociopathic personality” to cover the patterns that had traditionally be subsumed under the psychopath label. “Sociopathic” was used to emphasize the environmental factors allegedly generating the disorder and to de-emphasize the moralistic connotations that had become encrusted on the old terminology. Nevertheless, both concepts remained in lay and professional usages. The confusion was further heightened with the 1968 revisions of the Diagnostic and Statistical Manual (DSM-II), which included neither term; instead, the DSM-II substituted the label “antisocial personality disorder.” Although this new term carries an inherent implication of specifically criminal behavior, many professionals believed that it was a clear improvement in that it emphasized observable behavioral criteria: that is, to patterns of observable, definable behavior that conflict chronically with agreed-upon societal norms.

The trend toward objective criteria for the application of the term continues in the latest revisions of the Diagnostic and Statistical Manual, and the term “antisocial personality” disorder is also retained. It would be helpful if a specific psychopathic disorder diagnosis was included in the DSM, especially if references to overt criminality were minimized. Incidentally, if the individual is younger than 18, the appropriate diagnosis is conduct disorder.

From early on, studies have found that the term “psychopathic personality” is meaningful and useful in diagnosis. Also, in an early, landmark study, Spitzer and his associates (1967) checked for the diagnostic reliability of all of the standard mental health diagnostic categories, and found the highest level of agreement (r = .88) in the respondents’ ability to label persons in the category of antisocial personality.

As we see, there is considerable overlap between the terms “antisocial personality disorder” (the present official DSM term), the “psychopath,” and the “sociopath.” Throughout this article, we will use the overall term “antisocial personality,” recognizing that the psychopath (or sociopath) is typically seen as a subgroup of this category.

III. Characteristics of the Antisocial Personality (AP)

The essential characteristic of the antisocial personality disorder (AP) is the chronic manifestation of antisocial behavior patterns in amoral and impulsive persons. They are usually unable to delay gratification or to deal effectively with authority, and they show narcissism in interpersonal relationships. The pattern is apparent by the age of 15 (usually earlier) and continues into adult life with consistency across a wide performance spectrum, including school, vocational, and interpersonal behaviors.

A consensus of the research on the specific characteristics of the antisocial personality (and this research typically focuses on that narrower range of individuals seen as psychopathic) presents the following, i.e., relative to normals, they are (a) less physiologically responsive (e.g., by EKG, GSR, and EMG measures) to fearful imagery; (b) less psychologically responsive to social disapproval; (c) less responsive psychologically to affect-laden words, i.e., they respond cognitively but not affectively; (d) perseverate in behaviors with negative consequences even when they are intellectually aware of these consequences; (e) show more evidence of “cortical immaturity” but not significantly greater indices of brain dysfunction; and (f) show higher levels of sensation- and thrill-seeking behaviors.

Although the DSM-IV discusses only the overall category of AP, there is good evidence that it can be further subdivided into categories of primary psychopath and secondary psychopath. Primary psychopaths are distinguished by the following characteristics: (1) they have very low levels of anxiety, avoidance learning, or remorse; (2) they are even more refractory to standard social control procedures; (3) they are higher in sensation-and thrill-seeking behaviors, particularly the “disinhibition” factor that refers to extroverted, hedonistic pleasure seeking.

Both the secondary and the primary psychopath are quite different from those individuals who are antisocial because they grew up in and adapted to a delinquent subculture. These delinquent individuals are normal in relation to the subculture they were reared in; they follow (often almost obsessively) the rules and mores of this group. They can be as conformist as the good middle class, middle management person. As we have already noted, not all criminals are psychopaths, and not all psychopaths are criminals.

Cleckley (1955), a particularly influential early theorist, asserted that psychopaths are often intellectually superior, and this concept has unduly influenced attitudes toward the AP. However, Cleckley was clearly in error here; such a characterization best fits the unique subsample that he usually encountered with in his clinical practice. It is not surprising that those rare psychopaths who (a) were willing to participate and stay in therapy and, especially, who (b) could pay a private therapist’s fees would be brighter than the average psychopath. As a whole, all subgroups of antisocial personalities actually show lower than average scores on intelligence tests. This is logical considering their inability to adjust to school, and is especially so if genetic dysfunction and/or brain immaturity are involved.

Violent crimes of nonpsychopaths are often characterized by extreme emotional arousal and frequently occur in situations of domestic dispute. They are more often perpetrated against women who are known to the aggressor and can be loosely characterized as “crimes of passion.” On the other hand, the violent crimes of psychopaths are less affectively laden, being perpetrated most commonly against men unknown to the aggressor. Violence of psychopaths is often callous and cold-blooded, frequently stemming from a dispassionate search for revenge or retribution and displays of machismo.

IV. Heritability of Psychopathy

Cesare Lombroso’s very early theory that one can tell a criminal by certain physical features, such as a low forehead, has been discarded. However, though some still believe the genetic effect is not very strong, most modern researchers have shown that criminal behavior is affected by heredity, thus providing strong, though indirect, support for the belief that the AP also is affected by heredity.

V. Difficulties in Studying the Psychopath

There is a reasonable concern that some of the research data available on AP’s are not based on adequate sampling techniques. Two populations are a favorite target of researchers: (1) persons (often college students) who score high on the Psychopathic Deviate (Pd (4)) scale of the Minnesota Multiphasic Personality Inventory (MMPI) and (2)incarcerated criminals. There are problems with both groups. Individuals high on the Pd scale (as is true for a significant number of psychology graduate students and medical students) may be creative, productive individuals who are contributing positively to society even though they do not accept some of the standard social mores.

The use of an incarcerated criminal population is also a questionable practice. First, it assumes that the great majority of AP’s are unsuccessful and, second, that they are lodged in prisons. There are data (some cited earlier) that refute both of these assumptions, and logic would argue otherwise. The most critical error lies in the assumption that the criminal population is largely composed of AP’s. Anyone familiar with prisons is all too aware of the polyglot of individuals in residence.

VI. Assessment Measures with Antisocial Personality Disorder

Numerous tests, e.g., MMPI-2, provide a narrow or indirect evaluation of psychopathy. However, empirical evidence gathered over the course of the past 10 years indicates that Hare’s Psychopathy Checklist (PCL) and its revised form (PCL-R) offer one of the most promising methods of assessing psychopathy directly and comprehensively, yet reliably. The PCL-R is a 20-item revision of the original 22-item scale (Hare, 1980) designed to measure not only behaviors, but also inferred personality traits central to the traditional clinical conceptualization of psychopathy. Assessment is based on a semistructured interview (about 90-120 minutes) and a review of file information. The interview serves not only as a source of information about the subject, but also allows the examiner an opportunity to observe the person’s interpersonal style.

Scoring is based on a three-point scale (0, 1, or 2). Scoring criteria are well delineated and allow satisfactory interrater reliability of .83 for a single rating and .92 for the average of two ratings. The total score can range from 0 to 40 with higher scores indicating a closer match to the psychopathic prototype. Although scores fall along a continuum, a cutting score of 30 is recommended as the best diagnostic indicator and this cutoff is currently being used in most studies of forensic populations. In such populations the mean score is usually between 20 and 25 with a standard deviation of approximately 7.

The psychometric properties of the PCL-R have been well documented and there is extensive evidence to support the measure’s reliability and validity. Also, the base rate of psychopathy and the psychometric properties of the PCL for adolescents are similar to those obtained with adult male offenders.

In addition, it does not appear that shortening the test severely compromises the positive psychometric properties, especially in civil populations. The PCL:SV, a 12-item screening version of the PCL-R, has been tested on both criminal and civil populations and has shown good psychometric properties. It has slightly lower reliability than the full-length version, with which it correlates at about .80. Testing is based on a 30- to 45-minute interview and less extensive file information. Scores range from 0 to 24 with a score of 18 or higher being a good indicator of psychopathy. While this measure is easier to administer and flexible enough to be used in a variety of populations, the fulllength version is still the best measure in forensic populations and should be used whenever this is feasible.

VII. PCL-R-Generated Concepts

There is substantial evidence that psychopathy, as measured by the PCL-R, consists of two stable, main factors, and both factors show good interrater reliability and internal consistency. The more behaviorally oriented Factor 2 demonstrates slightly higher reliability than Factor I which is not surprising since there is less subjectivity involved in the scoring of Factor 2 items. However, greater internal consistency is shown by items loading on Factor I which is consistent with the idea of a core set of psychopathic personality traits. The factor components are as follows:

Factor 1:

  1. Glibness/superficial charm,
  2. egocentricity/grandiose sense of self-worth,
  3. pathological lying,
  4. conning/lack of sincerity,
  5. lack of remorse,
  6. shallow affect,
  7. callousness/lack of empathy,
  8. failure to accept responsibility.

Factor 2:

  1. Need for stimulation/proneness to boredom,
  2. parasitic lifestyle,
  3. poor behavioral controls,
  4. early behavior problems,
  5. lack of realistic long-term plans,
  6. impulsivity,
  7. irresponsibility,
  8. juvenile delinquency,
  9. revocation of conditional release.

Factor 1 is positively related to clinical ratings of psychopathy and with personality measures of narcissism, dominance, and Machiavellianism. It is negatively correlated with nurturance, agreeableness, empathy, anxiety, and DSM diagnoses of avoidant and dependent personality disorders. Factor 2 is related to disruptive prison behavior, drug and alcohol problems, and DSM-IV APD. It is negatively correlated with conscientiousness, socialization, SES, employment, education, and IQ.

There is evidence that the diagnosis of psychopathy via the PCL-R predicts recidivism even after such variables as criminal history, previous conditional release violations, and relevant demographic characteristics have been controlled. The behavioral and lifestyle variables of Factor 2 are important in the prediction of general recidivism, while the personality characteristics that compose the first factor are more important in predicting violent recidivism. This finding is consistent with the view that violent psychopaths are more persistent and instrumental in their use of violence than nonpsychopaths.

Yet, while the PCL-R demonstrates impressive incremental validity in predicting violence, especially considering the severe restriction of range under which it functions, the usefulness of the PCL-R should not be overgeneralized. One should not infer from extant supporting research that the PCL-R is able to consistently predict violent behavior in the general population. So far, it appears that the usefulness of the psychopathy construct in predicting violence presupposes some history of violent behavior.

VIII. The Psychopath and the Major Theoretical Orientations

This section presents conceptualizations of the psychopath within the framework of the dominant theoretical orientations in psychology, e.g., psychodynamic, learning/behavioral, cognitive, existential, and finally biological, followed by a proposed etiological model.

A. Psychodynamic Concepts

Blending psychodynamic and ethological perspectives, psychodynamic theorists such as John Bowlby have argued for the selective advantage of strong emotional attachments on the part of young animals toward their primary caregivers. Studying children in orphanages who had been reunited with their parents after long separations, Bowlby extended these ethological theories to humans and elaborated on a number of pathological attachment styles, e.g., clinging-dependent, anxious-ambivalent, and avoidant.

Clearly the attachment style of the psychopath would be “avoidant,” since an inability to form meaningful attachments with others is a cardinal symptom of psychopathy. Given the frequency of lax, inconsistent, and often violent parenting in the families of psychopaths, it is not surprising that a budding antisocial would learn that social independence, self-sufficiency, and even interpersonal manipulation are the best defenses in a hostile, unsupportive, unnurturing world. To remain unattached is the best prevention against frustrated attachment.

This viewpoint may account for the psychopath’s peculiar blend of affective blandness interspersed with occasional fits of angry, gratuitous violence. The great majority of the time, the psychopath is the ultimate “well-defended” person–cold, unfathomable, and unflappable. The angry, frustrated inner child is usually buried so deeply that it is seldom available to the others, or to the psychopath himself.

His developmental needs for nurturance, trust, and acceptance gone sorely unmet in childhood, the psychopath rises above his blocked needs by developing a “moving against” interpersonal style. Feeling profoundly inferior at one psychological level, the psychopath “rises above” others by dragging them down–manipulating, exploiting, humiliating, and perhaps even physically tormenting them to this end. Generally lacking education and socially accepted skills, the psychopath may even come to take special pride in his talent for antisocial and criminal pursuits.

B. Learning/Behavioral Concepts

The issue of conditionability is noted earlier in this research paper. To amplify, the learning viewpoint also emphasizes early experience with primary caregivers, but frames these interactions more in terms of reinforcement and punishment. The basic notions here are that the parents of psychopaths are inconsistent and punitive in their parenting behavior. The apparently random quality of the caregivers’ behavior teaches the young psychopath that others’ treatment of him is not contingent upon his behavior. Moreover, because he is so frequently punished, and most often on a noncontingent basis, he eventually becomes enured to punishing consequences in general. Child-rearing patterns such as these may contribute to the fact that adult psychopaths do not learn from the punishing consequences of life mistakes, as well as the finding that, in learning experiments, psychopaths ignore negative consequences and focus only on potential rewards.

C. Cognitive Concepts

At first glance, the cognitive model seems to have little to add to the discussion of the origins of psychopathy. Especially as articulated in the early writings of Aaron Beck and Albert Ellis, this model has focused less on etiology and more on here-and-now intervention. However, the following existential model certainly provides a cognitive perspective. Also, consider the underlying cognitive schemas that Beck finds to be facilitative of psychopathic behavior, as discussed in the upcoming treatment section.

D. Existential Concepts

It is interesting to view the psychopath from this perspective because of its heavy emphasis on such notions as guilt, anxiety, and freedom. From a point of view influenced by Friedrich Nietzsche’s writings, the psychopath is the most free person in the world (this may sound odd given the frequency with which psychopaths are incarcerated). Because he has suppressed it, or is not capable of experiencing it, he is not encumbered by the guilt and anxiety which would interfere with free, self-determined action in the world-he is not a “lamb.” He has transcended the conflict and discontent befalling most who struggle to have their needs met in the context of a prohibiting society. He is willing to live with “dirty hands.”

Existentialists often focus not only on freedom, but also on death, isolation, and meaninglessness. We might even admire the psychopath in terms of his ability to confront, accept, and embrace death in the form of reckless and dangerous behavior; we might admire his ability to embrace his ultimate isolation and “go it alone”; and we might even grudgingly come to respect his having grasped the purposelessness of existence and then choicefully imposed his own meaning on it, however cruel and perverse its manifestations might be.

But upon closer examination, we see that the psychopath does not really comfortably fit within the existentialist model. He has not really grappled and struggled with the conflicts inherent in choicefulness, e.g., the anxiety which follows from passing up opportunities which will never come again, the guilt which comes with inadvertently hurting others by one’s decisions (the psychopath is willing to live with dirty hands because he does not experience them as dirty). And, not having struggled, the psychopath can never experience the wholeness which comes from growth through pain.

We see that he is reacting against others rather than for himself. We see that he is a slave to his impulses, not master of his fate. From a gestalt point of view, we see that he is so hardened and defended that he does not really experience the world. He is not in touch with, or “aware” of the environment in a way that would allow him to act freely in accord with it, rather than haphazardly against it. We see that he is not only alienated from others, but almost completely alienated from his deeper self.

E. Biological Concepts

This paper already notes that heritability has a strong role in the development of psychopathy, and some authors have hypothesized a biological link with such childhood disorders as attention-deficit hyperactivity disorder (ADHD). Additionally research has noted several biologically based correlates, including reduced arousal to fear-inducing stimuli, minimized startle responses, restricted affective range, inability to respond affectively to emotion-laden words, reduced conditionability, and a tendency to perseverate in terms of attention allocation. But there is more to be said.

Whereas learning and psychodynamic models emphasize the effects of parents’ temperaments on children’s behavior, biologically based models emphasize the effects of children’s temperaments on parents’ behavior. For example, consistent with this thinking, research has shown that because of failure to obey, antisocial children were able to elicit punitive behavior from mothers of children who had never even met them before. Psychopaths apparently elicit relatively rejecting responses from parents by being underemotional and unresponsive, by being overly active and thereby annoying, and/or by having little natural tendency to engage their parents socially.

Also, research supports the notion that some individuals (especially psychopaths) have lower baseline levels of arousal than others. In order to achieve optimal levels of arousal, these individuals require more frequent and intense environmental stimulation. It follows that in their attempts to seek out sensational experiences they would be more likely to engage in antisocial acts, i.e., low levels of conditionability and high needs for sensation-seeking combine to create high levels of antisociality and impulsivity.

IX. Proposed “Common Path” for the Development of Psychopathy

A. Pre-existing Risk Factors

  1. Biological (prenatal, birth) disruption
  2. Low SES
  3. Family history of vocational-social-interpersonal dysfunction
  4. Family history of psychopathy

B. From Birth to School Age

  1. Child temperament factors

(a) Child’s lack of emotional responsiveness and lack of social interest fosters rejecting responses from parents

(b) Child’s high activity levels may cause parental annoyance and elicit punitive responses

  1. Parental factors

(a) Inconsistent parenting results in child’s failing to learn behavioral contingencies

(b) Aggressive, punitive parenting results in child’s modeling aggression, experiencing hostility, becoming enured to punishing consequences, and developing a repressive defensive style (emotional “hardness”)

  1. Parent-child interaction

(a) Unreliable parenting results in insecure attachment (i.e., interpersonally “avoidant” at tachment style); child “goes it alone” rather than risk rejection and disappointment associated with unreliable and/or abusive parents

C. School Age to Adolescence

  1. Predisposing personality factors

(a) Low baseline level of arousal (i.e., Eysenck’s biological extraversion) contributes to impulsive, undercontrolled, and sensation-seeking behavior

(b) A synergy of physiological underarousal, repressive psychodynamics, and habitual “numbness” to social contingencies results in child being insensitive to, and unable to, “condition” to environmental events; therefore, does not learn or “profit” from experience

(c) ADHA/”soft” neurological disorder overlay may exacerbate behavior problems

  1. Personality development

(a) Peer/teacher labeling may result in self-fulfilling-prophecy effects

(b) School and social failure result in sense of inferiority and increased interpersonal hostility; child develops “moving against” interpersonal style

(c) Initial forays into antisociality (e.g., theft, fire setting, interpersonal violence) occur; evidence for diagnosis of conduct disorder mounts

D. Adolescence

  1. The young psychopath hones exploitative style in order to express hostility and “rise above” feelings of inferiority; “proves superiority” by hoodwinking and humiliating teachers, parents, peers
  2. Continued antisocial behavior results in initial scrapes with the law
  3. Physiological impulsivity, inability to profit from experience (exacerbated by a perseverative attentional style), and interpersonal hostility and antagonism combine to make repeated legal offenses highly probable
  4. Contact with other antisocials in the context of juvenile-criminal camps or prison results in “criminal education”; increased criminality resuits; criminal and antisocial behavior become a lifestyle at which the psychopath can “excel.”

E. Adulthood

  1. Antisocial behavior escalates through the psychopath’s late 20s; increasingly frequent incarcerationresults in increased hostility and hardened feelings
  2. Unable to profit from experience, lacking in insight, and unable to form therapeutic bonds, the psychopath becomes a poor therapy-rehab risk and bad news for society
  3. Antisocial behavior decreases or “burns out” in an uneven fashion beginning in the early 30s (less so with violent offenses); this may be due to lengthier incarcerations, to changes in age-related metabolic factors which formerly contributed to sensation-seeking and impulsive behavior, or perhaps to decrements in the strength and stamina required to engage in violent or felony-property crimes.

X. Antisocial Personality Disorder Intervention Issues

Nearly all significant theorists and researchers suggest that psychopaths are poor therapy candidates, and there is some evidence that the more severe, or primary, psychopaths may get worse with psychotherapy, i.e., psychotherapy may provide a “finishing school” experience for them. The treatment problem with all the personality disorders–getting the client into therapy and meaningfully involved—is acute in the antisocial personality disorder. And, to the degree the person shows primary psychopathy, the poorer are the chances for any meaningful change, no matter what treatment is used.

Most effective are (1) highly controlled settings, (2) with personnel who are firm and caring yet sophisticated in controlling manipulations, (3) and in which the antisocial client resides for a significant period of time (and these appear to be effective only while the psychopath is in residence). Any inpatient treatment program should include four major components: (1) supervision, manipulation of the environment, and provision of education by the staff to facilitate change; (2) a token economy system that requires successful participation for one to receive anything beyond the basic necessities; (3) medical-psychiatric treatments to deal with ancillary psychopathology, e.g., neurological disorders, depression; and (4) a system of necessary social cooperation to maximize conformity and encourage development of the group ethic. This last component is seldom a consideration. In such a program every task that can be found that can reasonably be performed by another and which is not essential to health should be required to be performed only by one inmate for another. This is truly an area where the psychopath is a neophyte.

Attention should also be paid to the AP’s high level of stimulation-seeking. This need can be interpreted to the person with an antisocial personality disorder as similar to that of the alcoholic, in that the person will be driven to fulfill this appetite in one way or another. Therapists should attempt to work with psychopaths to develop methods, e.g., developing a consistent pattern of engagement in sports and other strenuous and/or exciting activities and jobs that provide for a high level of activity and stimulation.

Overall, a therapist would generally need to:

  1. As noted, expect resistance to entering therapy, and then to staying in therapy.
  2. As noted, consider their proneness to boredom and their high level of stimulation-seeking.
  3. Expect such clients to be deceptive about their  history and present status. To the degree feasible, independently corroborate any critical questions about history or present behaviors. Contract ahead of time that if you feel it necessary, you will obtain such data from significant others, etc.
  4. In line with the above, clearly confront the individual’s psychopathy and any record of deviant behavior. The presentation of “objective” profiles from tests like the MMPI-2 or 16 PF can be effective here. Confront the psychopathology as a lifestyle disorder that will require treatment of a significant duration (and cost); thus, one might contract for some financial penalty for early withdrawal. At the same time, avoid the role of judge, and stay as much as possible in the role of collaborator. Maintaining a degree of adequate rapport is critical. Any exercises that help to develop empathy or social sensitivity are useful.
  5. Challenge the following underlying beliefs as adapted from Beck et al. (1990): (a) rationalization–“My desiring something justifies whatever actions I need to take”; (b) the devaluing of others–“The attitudes and needs of others don’t effect me, unless responding to them will provide me an advantage, and if they are hurt by me, I need not feel responsible for what happens to them”; (c) low-impact consequences–” My choices are inherently good. As such, I won’t experience undesirable consequences or if they occur, they won’t really matter to me”; (d) “I have to think of myself first; I’m entitled to what I want or feel I need, and if necessary, can use force or deception to obtain those goals”; (e) “rules constrict me from fulfilling my needs.”

A. The Issue of Antisocial Burnout

Some solace may be achieved in the notion that psychopathic-antisocial behavior may diminish with age, independent of intervention. Fortunately, there is some empirical validation of this notion. Usually the downward trend begins after age 40, but unfortunately there appears to be no significant drop-off in violent crime for the true (high on Factor 1) psychopaths. And, though often at a diminished rate in nonviolent crime, more recent research suggests that more than a third of psychopath offenders remain criminally active throughout their adulthood.

XI. Summary

The antisocial personality presents a murky conflux of five axioms: (1) an apparent rationality and social appropriateness; (2) an apparent inability to process experience effectively under standard social controls and punishments; (3) some evidence of behavior-determining variables, such as genetic defect and/or brain dysfunction; (4) an absence of evidence of mediating variables between these possible causes and eventual antisocial behavior; and (5) a disinterest in changing oneself, and a lack of positive response to imposed treatment methods.

However pessimistic the picture regarding treatment potential, more psychopathic treatment and outcome studies are warranted, even if they focus on only the small improvements which are made by that small percentage of psychopaths who would stay in treatment. Since psychopaths, as a relatively small percentage of the population, commit such a large percentage of violent and property crimes, even a 5-10% success rate may pay dividends in terms of overall reduction of the most severe offenses.


  1. Beck, A., and Freeman, A., et al. (1990). “Cognitive Therapy of the Personality Disorders.” Guilford, New York.
  2. Cleckley, H. (1955). “The Mask of Sanity.” Mosby, St. Louis.
  3. Eysenck, H., and Gudjonsson, G. (1989). “The Causes and Cures of Criminality,” Plenum, New York.
  4. Hare, R. (1991). “The Hare Psychopathy Checklist-Revised.” Multi-Health Systems, Toronto.
  5. Hare, R., Harpur, T., Hakstian, A., Forth, A., Hart, S., and Newman, J. (1990). The Revised Psychopathy Checklist: Reliability and factor structure. Psycbol. Assess. 2, 338-341.
  6. Megargee, E., and Bohn, M. (1979). “Classifying Criminal Offenders.” Sage, Beverly Hills.
  7. Meyer, R. (1992). “Abnormal Behavior and the Criminal Justice System.” Lexington Books, Lexington, MA.
  8. Serin, R. (1991). Psychopathy and violence in criminals. J. Interpersonal Violence 6, 423-431.
  9. Spitzer, R., et al. (1967). Quantification of agreement in psychiatric diagnosis: A new approach. Arch. Gen. Psychiatry 17, 83-87.
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