Psychopathy is a condition characterized by the absence of empathy and the blunting of other affective states. Callousness, detachment, and a lack of empathy enable psychopaths to be highly manipulative. Nevertheless, psychopathy is among the most difficult disorders to spot.
Psychopaths can appear normal, even charming. Underneath, they lack any semblance of conscience. Their antisocial nature inclines them often (but by no means always) to criminality.
Psychopaths spark popular fascination and clinical anguish: Adult psychopathy is largely resistant to treatment, though programs exist to treat callous, unemotional youth in hopes of preventing them from maturing into psychopaths.
Brain anatomy, genetics, and a person’s environment may all contribute to the development of psychopathic traits. For more on causes, symptoms, and treatments of the related condition called antisocial personality disorder, see our Diagnosis Dictionary.
Psychopathy is a spectrum disorder and can be diagnosed using the 20-item Hare Psychopathy Checklist, which features traits such as lack of empathy, pathological lying, and impulsivity, each scored on a three-point scale based on whether the item does not apply (0), applies to a certain extent (1), or fully applies (2) to the individual. The bar for clinical psychopathy is a score of 30 or higher; serial killer Ted Bundy scored 39.
The checklist was developed in the 1970s by the Canadian researcher Robert Hare. A true assessment should be conducted by a mental health professional.
The revised version of the checklist includes the following characteristics:
Grandiose sense of self-worth
Need for stimulation/proneness to boredom
Lack of remorse or guilt
Shallow affect (i.e., reduced emotional responses)
Callous/lack of empathy
Poor behavioral controls
Promiscuous sexual behavior
Early behavioral problems
Lack of realistic, long-term goals
Failure to accept responsibility for one's own actions
Many short-term marital relationships
Revocation of conditional release (from prison)
Criminal versatility (i.e., commits diverse types of crimes)
Psychopaths exist across cultures and ethnic groups. It has been estimated that approximately 1 percent of males and 0.3-0.7 percent of females could be classified as psychopaths. An individual may show elevated levels of multiple traits associated with psychopathy without qualifying as a psychopath according to a measure such as the Hare checklist.
An individual may exhibit early characteristics associated with psychopathy—called “callous-unemotional traits”—as early as childhood (before age 10) and may receive a formal diagnosis such as conduct disorder. However, showing psychopathic features in childhood does not mean that a person will necessarily become an adult psychopath.
Like other personality traits, psychopathic traits are substantially influenced by genetics, though research suggests that non-genetic factors are involved as well. Scientists have observed signs of atypical functioning of particular brain areas (such as the amygdala) in people with psychopathic traits. But there is much to be learned about the causes of such differences.
The Psychopathy Checklist-Revised (PCL-R) and the Psychopathic Personality Inventory (PPI) are the tests used by clinicians and forensic psychologists to assess antisocial behavior. Both focus on criteria that capture a callous unconcern for others, or what the PPI terms “coldheartedness.”
A high score on an established measure of psychopathy signals traits (such as callousness) that could pose a serious obstacle to successful therapy. There is evidence that psychopathic traits and associated antisocial behaviors can wane over the lifespan, but the extent to which psychopathic traits can be altered by therapy is not fully known.
The classic adage is that if you have to ask whether you’re a narcissist, you aren't. Not so with psychopathy. Some suspect that they have the condition because they lack appropriate empathic and affective responses from a young age. The only way to be certain is to consult a mental health professional and seek testing.
Individuals with antisocial personalities have distinct histories and combinations of traits—and their misbehavior can vary in nature and severity—so the terminology used to describe such people can get a little complicated. People often conflate the terms “psychopath” and “sociopath” or use both of them to describe those who flagrantly disregard moral rules.
While these terms are widely used in clinical and common language, the Diagnostic and Statistical Manual of Mental Disorders (DSM) uses neither “psychopath” nor “sociopath” as diagnostic terms. These descriptions are most closely represented in the DSM by a condition called antisocial personality disorder (ASPD).
The terms “psychopath” and “sociopath” are often used interchangeably, but a “sociopath” refers to a person with antisocial tendencies that are ascribed to social or environmental factors, whereas psychopathic traits are thought to be more innate. That said, both genetic and non-genetic causes likely play a role in shaping any person with antisocial traits.
Antisocial personality disorder overlaps with psychopathy, but is not the same condition. A person can meet the criteria for antisocial personality disorder—which focus largely on antisocial behaviors—without showing core traits associated with psychopathy. Psychopaths are thought to comprise just a fraction of people with antisocial personality disorder.
One conception of psychopathy separates “primary psychopathy” and “secondary psychopathy,” with the latter type showing more anxiety and emotional instability and attributed to environmental factors such as early mistreatment. Psychopaths can show significant temperamental differences and may come in distinct variants; it is unlikely, however, that any type is caused solely by genetics or parenting.
Men are more likely than women to meet the clinical bar for psychopathy, but even among psychopaths, females appear to be distinct in some ways. For example, research suggests that female psychopaths tend to be less physically violent than males and may have more anxiety and worse self-image.
For some, “psychopath” may seem synonymous with “criminal” or “killer," but the reality of psychopathy is more complicated. Scientists have indeed found statistical associations between psychopathy scores and violent behavior, as well as other forms of criminality. Elevated impulsiveness, tendency to deflect blame, and other antisocial traits may make a psychopath more inclined than other people to cross moral boundaries and threaten, hurt, or kill.
Yet the link between psychopathy and violence is far from one-to-one. Not all psychopaths are killers or even criminals, and there are other personality traits and forms of pathology aside from psychopathy that may contribute to aggressive behavior.
It is unknown how many psychopaths commit severe acts of violence. Among convicted killers, more than a quarter could be considered psychopaths (compared to about 1 percent of the general population), according to one estimate—and there’s evidence that psychopathic criminals are more likely to re-offend. But many psychopaths do not have histories of violence.
Not necessarily—though many (perhaps most) serial killers exhibit psychopathic personalities, showing a lack of empathy for their victims and no remorse for their crimes.
While psychopaths do not seem to completely lack the ability to experience fear, research suggests that they have a muted fear response to threats, which may make them more likely to engage in risky behavior. “Fearlessness” is one of the traits assessed by an alternative psychopathy test called the Psychopathic Personality Inventory.