What Makes Female Psychopaths Different?

Callous and opportunistic, female psychopaths are the rarest of a rare breed. Though they share much with their male counterparts, they may be even better equipped to elude detection.

By Katherine Ramsland, published June 24, 2019 - last reviewed on July 3, 2019

Elinor Carucci
Elinor Carucci

Young woman dreams up a false identity and infiltrates high society, scamming people out of hundreds of thousands of dollars. Caught in the act and sentenced to years in prison, she insists she isn’t sorry. A celebrated CEO wields a magnetic demeanor and a penchant for charming stories, selling a product that’s eventually exposed as faulty. She pushes back against critics, but the facade collapses and litigation ensues.

When an individual with such a record enters the public eye, we might wonder if she’s a psychopath.

Charm, lies, manipulation, and a lack of remorse—these are the marks of a psychopath. Such people understand social rules but prioritize their own self-interest. We often see this attitude on display in fiction: On Killing Eve, a popular television series, the beautiful assassin Villanelle freely exploits people to reach her goals. Mark Freestone, a senior lecturer in psychiatry at Queen Mary University of London and the show’s consultant, points out that she views people as merely a means to an end. She “feels no remorse for her actions, lies easily and without hesitation, and relates to other people in a very distorted way,” he told BBC America.

Until the 2000s, most research on psychopathy used male participants, assuming that the findings would transfer to females. That assumption was only partly correct. Male and female psychopaths show similarities on core characteristics such as lack of empathy and remorse. But the ways in which psychopaths process information, make decisions, and behave appear to differ between the sexes. Female psychopaths are typically less violent than males, though they can be just as remorseless and manipulative.

Clinicians generally don’t expect females to be psychopaths, so they might miss key signs. It is important to note that professional ethics enjoin experts from diagnosing someone they have not personally evaluated, but some do offer opinions when solid biographical information shows a person’s behavior to be consistent with psychopathy. In such cases, details of the person’s life must be observable enough to data collectors for an evaluation. Since more data is available for killers and con artists than for “mean girls” who merely defy social conventions, they are disproportionately represented in case studies of female psychopathy.

Using trial transcripts, videotapes, and books, Christine Sarteschi, an associate professor of social work and criminology at Chatham University in Pennsylvania, was able to evaluate Jodi Arias through the lens of psychopathy. In 2013, Arias was convicted of the 2008 murder of her former boyfriend, Travis Alexander, in Mesa, Arizona. She shot him, repeatedly stabbed him, and cut his throat to near decapitation. His wounds suggested that he had fought for his life. Under arrest, Arias offered several successive versions of the event: She was not present; she was present, but armed intruders killed Travis; she killed Travis, but in self-defense. She swore that each lie was true, smiled broadly for her mugshot (anticipating its internet presence), and tried to charm her interrogators.

“I believe her demeanor was consistent with that of a psychopath,” Sarteschi says. “She lied, got caught, and then lied again. With her constantly changing plot and characters, she acted as if her repeated lying would cast no doubt upon her veracity.”

Sarteschi found that Arias exhibited superficial charm, a grandiose sense of self-worth, a propensity for manipulation, a lack of empathy, and sexual promiscuity. Always prepared to distort facts for her own advantage, when caught in lies, she easily pivoted to revise them. Arias flirted with reporters, displayed a narcissistic sense of entitlement and invulnerability, and threw Travis under the bus to make herself the victim.

Elinor Carucci
Elinor Carucci

What makes a female psychopath?

To understand what distinguishes female psychopaths from males, it helps to have a feel for who psychopaths are more generally.

The development of psychopathy is a complex interaction of biology, culture, and environment. Genetic factors influence predispositions and temperament. Researchers have posited that there are two subtypes of psychopath: The primary type shows distinct neurological deficits and a blunting of emotions, while the secondary type exhibits more anxiety, substance abuse, and other mental health problems.

Psychopaths are not all violent, but when they are, they tend to be cruel and criminally diverse. They repeat their crimes more often than nonpsychopathic offenders, they’re more destructive, and their offenses are primarily those that involve self-gain, such as theft or selling illegal drugs. Many are predatory, acutely attuned to their own advantage.

Psychopaths exist across cultures and ethnic groups and at an estimated frequency of about 1 percent of the population for males and 0.3–0.7 percent for females. Some researchers challenge these numbers, citing bias toward male manifestations in diagnostic instruments and methods. For example, males living off females might score high as parasitic—a psychopathic behavior—while cultural norms shield females who live off males from a similar evaluation.  In 1941, American psychiatrist Hervey Cleckley published The Mask of Sanity, which remains a classic study of psychopathic behavior. Through multiple editions, Cleckley distilled 16 traits and behaviors that herald psychopathy, including irresponsibility, self-centeredness, superficial charm, and dishonesty. Among his published cases was “Anna,” a striking woman who seemed educated and urbane, despite her fake British accent. As a teenager, she was manipulative, promiscuous, and cruel. In one incident, she urinated on other girls’ evening dresses. She lied frequently and stole cars. Although she was compulsively unfaithful in her relationships, she thought she was highly trustworthy. “Perhaps, despite a high capacity for intelligence and charm,” Cleckley wrote, “something necessary for wisdom or for sincere and major human feelings was left out or incomplete in her development.”

Researchers needed the means to gather empirical data to support Cleckley’s clinical construct. Canadian psychologist Robert Hare created such a device, reporting the development of an initial checklist in 1980. The revised version of his Hare Psychopathy Checklist, the PCL-R, is currently the most validated diagnostic instrument for psychopathy. It frames the condition as a distinct configuration of high scores on 20 traits and behaviors. These include interpersonal and emotion-related characteristics like pathological lying and lack of remorse, as well as aspects related to lifestyle and antisocial behavior, such as lack of realistic plans for the future and early behavioral problems. Each item is rated from 0 (definitely not present) to 2 (definitely present). The highest possible total score is 40, and a score over 30 designates a psychopath. (Some experts use a cutoff of 25.)

Serial killer Aileen Wuornos received a score of 32. She murdered seven men in Florida between 1989 and 1990 and claimed to authorities that she would kill again. Forensic psychiatrist Wade C. Myers and two colleagues who evaluated her concluded that she probably had a biological predisposition that made her vulnerable to developing the disorder, but they believed that stress and trauma in her background had contributed to her aggression and emotional instability.

When the checklist is used to assess female offenders, “the scores tend to be a few points lower than for male offenders,” Hare says, adding that “the predictive power of the PCL-R is much the same for female and male offenders.” Females with higher psychopathy scores offend at a higher rate and show deficits in conceptual reasoning, mental flexibility, and problem-solving. They excel at deception and manipulation. Using a shortened, self-report version of the checklist, a 2015 study of 343 females showed that they had higher scores on the interpersonal and lifestyle facets of psychopathy (manipulativeness, grandiosity, impulsivity) than they did on emotional and antisocial facets (lack of remorse and delinquency).

Overall, according to researchers, female psychopaths seem to be less physically violent than males. While the evidence on gender differences is mixed, females who develop the disorder may show it through verbal and relational aggression—perhaps harming someone socially through gossip or ostracism. Female psychopaths appear to have a stronger need for others’ approval, worse self-image, and more anxiety relative to males. They might use flirtation and sexual behavior, feign suicide attempts, or pretend to be the victim of an assault to get what they want.

Antisocial personality disorder (ASPD) overlaps with psychopathy, but the two are not the same condition. ASPD relates largely to the behavioral aspects of psychopathy, so many people who meet the criteria for ASPD do not have the core personality characteristics. Nevertheless, research finds that ASPD, too, is less prevalent in women—at roughly one-third the rate in men, by one estimate—and females with the disorder show less overt violence.

Even when females with antisocial tendencies do become violent, the nature of the violence tends to differ from that committed by men. Psychiatrist Michael Stone and clinical psychologist Gary Brucato, authors of The New Evil, have both evaluated individuals who have committed serious offenses. Stone and Brucato find that female offenders demonstrate scattered traits, rarely achieving the score of 30 on the PCL-R. “The vast majority,” they say, “appeared to have these features in the contexts of histories of abuse and neglect.”

Motivations are often different for females: “Males tend to be motivated by sex or strivings for domination and power over victims; females tend to be driven more by profit, notoriety, or some other practical end.” Violent male psychopaths often harm strangers. But the authors note that when psychopathic females are serial killers, they typically target family members. “They do not tend to sadistically torture their victims, but to instead kill them expeditiously. We do not see the ‘severe violence for the sake of severe violence’ motivation.”  

Stone and Brucato cite Dorothea Puente as a female who displayed a wide array of psychopathic traits and behaviors. She ran a boarding house in the 1980s in Sacramento, California, offering cheap rooms and hot meals to the elderly and disabled. However, resident turnover was high. When one man went missing, a social worker notified police. Upon investigating, they dug up the lawn and garden and found seven bodies. Puente had forged signatures on numerous social security checks sent to her victims.

Elinor Carucci

Wolves in Sheep's Clothing

The caretaking business, it seems, offers easy access to potential prey.

Psychopaths are typically attracted to jobs involving power, status, excitement, and money. We don’t expect them to be nurses. Yet some do target the most vulnerable victims, easily found in health-care facilities. Even there, they might not be who we think.

Catherine Wood, a supervisor at the Alpine Manor in Walker, Michigan, became romantically involved with Gwendolyn Graham, a nurse’s aide. One day in 1987, according to Wood’s later testimony, Graham proposed a deadly game. The eldercare facility recorded the names of deceased or discharged patients in a ledger. The original plan was that they would kill patients whose first initials of their last names, when read down the list, would spell M-U-R-D-E-R. They ultimately smothered five people over the course of a few months but then broke up when Graham began dating another woman.   

After Graham was convicted in 1989, psychologist Michael Abramsky evaluated her. She admitted to him that she cut herself, abused drugs, and had been sexually promiscuous. With neglect and abuse in her background, she had developed a callous and hostile attitude. Her moral development was “primitive,” and she lacked empathy. Yet Abramsky believed that Graham was not clever enough to have invented the game.

Michigan State Police psychologist Gary Kaufmann agreed. He suspected that Wood, who had turned on Graham for a reduced sentence, had been the mastermind—the game’s sophistication was more consistent with her style. She was a narcissist, he thought, and possibly a psychopath. The risk of her own incarceration when she admitted her part would not have stopped her from punishing the partner who’d left her. “The game of manipulation becomes more important than the outcome,” Kaufmann told Lowell Cauffiel, author of the book Forever and Five Days.

“Psychopaths tend to be personable,” says Beatrice Yorker, professor emerita of Nursing and Criminal Justice & Criminalistics at Cal State LA and an expert on health-care killers. “They make friends, and they often engage in splitting behaviors among the staff on the units where they work, so people don’t figure them out: They convince a lot of coworkers to believe that they’re good people who are victims of a witch hunt. The views are split, however, as other colleagues who sensed there was something wrong feel divided from those who support the nurse. We think [psychopaths] are pretty rare, but we have no way to screen them out unless they show their psychopathy in some other way, like falsifying their credentials or stealing patients’ belongings.”

Some female psychopathic offenders show symptoms of other conditions as well. There appears to be a link especially between psychopathy and borderline personality disorder (BPD), which is characterized by emotional instability, impulsive behavior, and unstable relationships. Psychologist Edelyn Verona, along with former graduate student Jenessa Sprague and colleagues, found support for a female-specific manifestation of psychopathy that overlaps with borderline personality traits, or a “borderline psychopath.” The two disorders also share neurological and cognitive similarities, which suggests that they have a common dispositional vulnerability.

Wuornos had received diagnoses of both antisocial personality disorder and BPD. She showed instability in her relationships and self-image, along with marked impulsivity and promiscuity. Typical of BPD, she could not tolerate being abandoned, used suicide attempts to manipulate, had difficulty controlling her anger, and alternated dramatically between idealizing and vilifying people in her life.

Despite overlap in some behaviors, however, these disorders have distinct differences. Psychopaths hope to orchestrate a con while those with BPD seek to meet desperate needs. People with BPD look for strength and stability in others so they can siphon it, while psychopaths attune to vulnerability. Psychopaths also don’t fear abandonment the way those with BPD often do.

Brucato notes the confusion this comorbid association creates. “If a Venn diagram were made, with the circles representing BPD and psychopathy,” he says, “there would be overlap at some junctures. This would most notably include impulsivity and poor behavioral inhibition. However, psychopathy and BPD are entirely independent diagnoses. Where there is an overlap, one is likely seeing psychopathic features secondary to abuse or neglect.” That is, psychopathic behaviors that look like BPD might stem from adverse experiences.

Jodi Arias received a BPD diagnosis during her evaluations for trial, but Sarteschi challenges it: “Individuals with borderline personality disorder experience a high degree of emotional instability, display behavior such as cutting, and have suicidal ideation. They struggle with self-image.” She thinks these descriptions do not apply to Arias, who “displayed great self-confidence. She was independent and always in control. Intentional deception is not a characteristic of borderline personality disorder. Arias’s behavior might be characterized as one unbroken act of deception. The evidence related to suicidal ideation appears to be, according to the prosecutor, superficial and only done with the purpose of getting out of jail.”

Careful attention to the differences between these disorders might lead to the identification of more female psychopaths.

Elinor Carucci
Elinor Carucci

Unlikely to Succeed

Whether male or female, the psychopathic brain differs anatomically from a nonpsychopathic brain. Along with other scientists, Kent Kiehl, a neuropsychologist at the University of New Mexico and the author of The Psychopath Whisperer, has compiled evidence that emotional and cognitive impairments in psychopaths—particularly those involved in social processes and moral reasoning—are related to abnormalities in parts of the brain, including the prefrontal cortex and the amygdala. Psychopaths have difficulty working their way through moral concepts and recognizing emotional expressions. They over-focus on reward and under-respond to the threat of punishment.

“I liken it to an emotional disorder with an adjunctive impulsivity problem,” Kiehl says.

A recent study on which Kiehl worked involved 83 female college students. Using a marker of functioning in the prefrontal cortex, a brain area involved in inhibition, they found evidence that aberrant functioning there may influence whether psychopathic lifestyle characteristics like impulsivity and affective ones like shallow emotions are linked to aggressive reactions to perceived provocations or frustration. Further, “women who lack remorse and empathy and have a callous disregard for others engage in higher levels of goal-directed aggression,” the study authors conclude.

“Our published data suggest that, at least in high-risk females, callous unemotional and conduct-disorder traits look very similar to what we see in males,” Kiehl says.

Unlike their male counterparts, however, females with psychopathic traits respond normally to emotional words. Despite impairments, they score better on emotional intelligence than males. Equipped with this ability, as well as greater boldness and thicker skin than normal females, it might seem a given that under some circumstances they could rise quickly into leadership roles.

Unfortunately for them, research suggests that the people who make management decisions will show little support for displays of coldheartedness or dominance in female leaders. Researchers recently undertook a meta-analysis of previous studies and reported evidence that psychopathic features tend to be tolerated or affirmed in men but not in women. Even if women with such traits are regarded as competent, negative evaluations could block promotion. Some may rise to power if they can charm their way upward, but once they show their true colors, they won’t necessarily stay there.

Add to this picture a highly developed short-term reward response and difficulty with future planning, and it’s easy to see why psychopaths prefer the con to long-range goals and distant reward.

Can a clearer view of psychopathy across the sexes, then, help us understand bold individuals who attain positions of wealth or influence only to tumble spectacularly in the end? We may not know enough to decide that a famous fraud or con artist is in fact a psychopath. But we can see how a woman with an ability to manipulate and dismiss consequences could rise rapidly. And how the weight of such a person’s lies could bring her down just as quickly.

Katherine Ramsland, Ph.D., is a professor of forensic psychology at DeSales University and the author of 65 books, among them The Mind of a Murderer and Confession of a Serial Killer: The Untold Story of Dennis Rader, the BTK Serial Killer.