Skip to main content

Verified by Psychology Today


Why It's So Hard to Predict Psychopathy

Some take cream in their coffee, some take it black.

Key points

  • There’s an impression that psychopathy is a uniform construct, but clinical analysis finds shades of gray.
  • These diverse manifestations have been posed as facets, categories, subtypes, and predominant characteristics.
  • Even as a refined construct, psychopathy is too complex for blanket statements about predictable preferences.
Photo by K. Ramsland
Photo by K. Ramsland

Modern culture is full of supposed research findings about psychopaths, claiming such things as their preference for black coffee, dark chocolate, crypto-currency, and business majors. Psychopathy, however, is not that homogeneous.

Just because a score on a diagnostic instrument correlates to certain preferences, we can’t conclude that most psychopaths will behave this predictably. That’s because the disorder is not as simple as the label conveys. The history of this construct shows the wide array of attempts to pin it down.

The condition of psychopathy involves a complex interaction of biology, culture, and environment. Genetic factors influence predispositions and temperament.

The “born” psychopath is considered a primary type, showing distinct neurological deficits and emotional blunting that manifest in diminished fear, guilt, and anxiety. Secondary psychopathy seems to form from environmental influences like deprivation and abuse. It’s more of a reactive condition, showing as misconduct, substance use, mental health problems, anxiety, and impulsivity. And not everyone in the clinical world agrees with these distinctions.

A "Wastebasket Effect"

Throughout the 19th century, psychiatry debated how to address this “mania without delirium.” By the early 20th century, clinicians and analysts were defining manifestations of psychopathy via different categories.

For example, German psychiatrist Emil Kraepelin, who emphasized biological malfunction, described four types: liars and swindlers, criminals by impulse, calculating and manipulative types, and morbid vagabonds. Kurt Schneider described passive and active psychopaths in The Psychopathic Personalities in 1923, proposing a typology that covered hyperthymic, depressive, insecure, fanatic, attention-seeking, labile, affectionless, explosive, asthenic, and weak-willed psychopaths. Six years later, Danish psychiatrist August Wimmer added categories like hysterical, instable, and sexually perverted. This lack of diagnostic specificity created a “wastebasket effect": the psychopathy label covered a lot of conditions.

By mid-century, the move was on to identify a specific syndrome. It was psychiatrist Hervey Cleckley who best crystallized the distinctive characteristics in The Mask of Sanity. During the 1940s, he identified 16 core traits and behaviors. Prison psychologist Robert Hare followed up later by translating these clinical interpretations into a standardized diagnostic instrument, the Psychopathy Checklist, currently in its revised version, the PCL-R. This scored 20-item list became the primary (but not sole) means of diagnosing a person as a psychopath.

The PCL-R organizes around two factors, each of which has two facets. Factor 1, interpersonal and affective facets, includes traits like grandiose, callous, manipulative, and lacking remorse. Factor 2, refers to lifestyle and antisocial behaviors, such as being aggressive, impulsive, irresponsible, and sensation-seeking. So, in a way, psychopaths are still characterized according to their outstanding manifestations.

Female Psychopathy

This variability continues when the construct extends to females. Until the 2000s, most research on psychopathy used male participants, assuming the findings would automatically transfer to females.

While male and female psychopaths do show similarities on characteristics like lack of empathy and remorse, female psychopaths are typically less violent. What's more, females with higher psychopathy scores show deficits in conceptual reasoning, mental flexibility, and problem-solving, and there appears to be a link between female psychopathy and borderline personality disorder.

Then, there are the alternate conceptions of psychopathy, such as the triarchic model, which emphasizes boldness, disinhibition, and malignant narcissism. Another diagnostic instrument, the Psychopathic Personality Inventory (PPI), focuses on fearless dominance and impulsive antisociality.

American personality psychologist Theodore Millon, divided psychopathy into 10 distinct manifestations, any of which could overlap with any other. Talk about variety!

On Millon's list, the “unprincipled psychopath” has no concern about the welfare of others. They tend to be dishonest and manipulative because they’re narcissistic and unremorseful. The “disingenuous” or “furtive” psychopath is friendly on the surface but irresponsible, undependable, demanding, and immature. The “covetous” psychopath feels entitled and, thus, justified in taking what they can, while the self-perceived weakness in the “spineless” psychopath inspires compensating with aggression.

Three other Millon types are more active: the sensation-seeking “risk-taking” psychopath, the “explosive” psychopath, and the “harsh” or “abrasive” psychopath all show their traits in obvious behaviors. More extreme are the “malevolent,” “tyrannical” and “malignant” psychopaths. The former are vindictive and punitive. They’re cold and cruel. Both of the latter types are more threatening. They freely accuse and abuse. Those who resist them only inspire them to cause more damage. The malignant psychopaths are also paranoid, alert to others trying to undermine them.

Matching Psychopathy Scores to a Preference Survey

From all of these types, which do we mean when matching the psychopathy scores to a preference survey? Does the risk-taker prefer black coffee or does the malignant type? The primary or secondary?

Historical accounts and clinical devices show plenty of evidence for the multifaceted nature of psychopathy. Thus, when researchers (or media) claim that “psychopaths prefer black coffee,” they enlighten no one about either psychopaths or coffee drinkers.

Facebook/LinkedIn image: Gorodenkoff/Shutterstock


Cooke, D. J., Michie, C., & Hart, S. D. (2006). Facets of clinical psychopathy: Toward a clearer measurement. In Handbook of Psychopathy, ed., Patrick, C. J. Guilford.

Hare, R. D. (2003). The Psychopathy Checklist-Revised. 2nd Edition. Toronto, Ontario, Canada: Multi-Health Systems.

Herve, H. (2007). Psychopathy across the ages: a history of the Hare psychopath. In The Psychopath: Theory, Research, and Practice, eds., Herve, H., & Yuille, J. Lawrence Erlbaum Associates.

Millon, T., & Davis, R. D. (1998). Ten subtypes of psychopathy. In Psychopathy: Antisocial, Criminal and Violent Behavior, eds, Millon, T., Simonsen, E., Birket-Smith, M. & Davis, R. D. Guilford Press.

Ramsland K. (2019, July). Why female psychopaths are a different breed. Psychology Today.…

More from Katherine Ramsland Ph.D.
More from Psychology Today