Are Psychopaths Unfairly Stigmatized?

Misconceptions about psychopaths abound, and even experts can get them wrong.

Posted Sep 20, 2018

Most people have heard of the word “psychopath” but not everyone is sure what it means. In fact, even experts disagree on what it means. Specifically, there is debate about to what extent psychopathy is characterized by antisocial and criminal behaviour, and whether it includes adaptive features. Additionally, a few studies have focused on how laypersons perceive psychopathy and how they think people labelled as “psychopaths” should be treated. Research suggests that layperson’s understanding of the concept is moderately accurate, although they have a few misconceptions themselves. The authors of a recent study (Durand, Plata, & Arbone, 2017) argue that people labelled as psychopaths are stigmatized by society and looked at how a person’s own psychopathic traits might influence their own attitudes to people diagnosed as psychopaths. Although this is an interesting topic, this particular study adds a few misconceptions of its own by downplaying the negative aspects of psychopathy. How people who are labelled as psychopaths are treated by society is an important topic, but discussion should be based on accurate information about psychopaths’ potential for violence and criminality.

Mental health experts define psychopathy as a personality disorder characterised by a collection of traits including lack of empathy, callous-manipulative traits, irresponsibility, and willingness to violate other people’s rights. There is ongoing debate about whether the concept of psychopathy should include adaptive socially desirable traits such as fearlessness and boldness (Lilienfeld et al., 2012; Miller & Lynam, 2012). Specifically, some have argued that traits such as low fear and social confidence are core features of psychopathy, while others have argued that the core of psychopathy consists of interpersonal antagonism (i.e., antisocial traits), and that fearlessness is only weakly, if at all, related to antagonism/antisocial behaviour, and is not, therefore, a core feature of the condition. Similarly, media portrayals of psychopaths have not only included characters with highly negative antisocial traits (e.g., the Joker, Hannibal Lecter), but those with more positive traits such as James Bond and Dr. Gregory House (Keesler & DeMatteo, 2017).

Wikimedia commons
The face of psychopathy? Ted Bundy in court
Source: Wikimedia commons

The paper I want to focus on (Durand et al., 2017) argues that excessively negative portrayals of psychopaths as ruthless killers by the media and popular culture have led to misunderstanding and stigmatization of this condition. Hence, they claim that laypersons see psychopaths as criminals and fear them because of “their supposed aggressive tendencies.” Stigmatization means “disqualification from full social acceptance,” which can lead to reduced employment opportunities, lower quality of healthcare, and an impoverished social life. They assert that this stigmatization is “due to lack of public awareness and information” about the condition. On the contrary, the authors boldly state that “the fear of psychopaths remains highly present in the general population” even though “a growing body of evidence suggests that psychopathy is not strongly linked to increased violence and criminal behavior.” All these statements made by the authors about psychopathy have problems, which I will return to later.

A few previous studies have examined how layperson’s perceive psychopaths (e.g., Furnham et al., 2009). Durand et al.’s study is somewhat novel in that they examine how a person’s own psychopathic traits are related to their attitudes to a person labelled as a psychopath. They assessed study participants’ psychopathic traits based on the triarchic model of psychopathy. In this model, psychopathy is thought to consist of a combination of three personality traits: meanness, disinhibition (i.e., lack of self-control, recklessness), and boldness (essentially fearlessness). As I mentioned earlier, there is debate about the importance of boldness/fearlessness in psychopathy. Experts generally agree that meanness is an essential defining feature of psychopathy, and that disinhibition is a close second in importance (Miller, Lamkin, Maples-Keller, & Lynam, 2016). Meanness and disinhibition are strongly positively correlated with each other and with a wide range of antisocial behaviours. However, boldness is only weakly related to antisocial behaviour and is not strongly related to either meanness or disinhibition. In fact, boldness is generally adaptive and is associated with good mental health (Lynam & Miller, 2015; Miller & Lynam, 2012). Nonetheless, some scholars still defend the inclusion of  boldness, also known as “fearless dominance,” in measures of psychopathy (Lilienfeld et al., 2012). Personally I disagree with the inclusion of fearlessness and have explored this in more detail in a previous post.

As well as assessing triarchic personality traits, Durand et al. asked participants in their study about their attitudes and beliefs about psychopaths. These included a wide range of items relevant to stigmatising attitudes, such as psychopaths’ propensity for violence and crime, morality, causes of psychopathy, rehabilitation potential, and supposedly adaptive features of psychopathy (such as intelligence and social skills). Additionally, participants read a short fictional description of someone diagnosed with psychopathy named Harry, and then answered a series of questions about their view of him. These questions related to four factors: how fearful and dangerous they thought Harry was; their willingness to help him if he was in need; their willingness to force Harry to accept treatment to cure his psychopath, even against his will; and negative emotions, i.e., how much they disliked Harry because of his diagnosis.

In the results of the study, there were a few negative correlations between participants’ psychopathic trait scores and their attitudes to psychopaths. Specifically, meanness and disinhibition, but not boldness, were negatively correlated with participants’ belief that psychopaths are prone to criminality, and positively correlated with their belief that psychopathy had noncriminal aspects. Additionally, boldness and meanness were negatively correlated with participants’ belief that psychopaths are prone to violence. The other attitudes and beliefs were not related to any of the three traits. That is, meanness was related to three of these attitudes, disinhibition to two of them, and boldness to only one. This suggests that participants high in meanness, and to a lesser extent disinhibition, had less negative, less “stigmatizing” views of psychopaths in terms of violence and criminality. Regarding, attitudes to Harry the psychopath, boldness had a moderate positive correlation with willingness to help Harry and a negative correlation with belief that he was fearful and dangerous. All three traits of meanness, and disinhibition were associated with lower levels of negative emotion towards Harry, although in multiple regression analysis, only boldness was significant. That is, of the three traits, boldness was the only one that was uniquely related to reduced negative emotion towards Harry. None of the traits were related to attitudes to forcing treatment on Harry.

Durand et al. suggested that their finding that psychopathic traits, especially meanness and disinhibition, were related to less belief that psychopaths tend to be violent and criminals might indicate that people high in these traits might feel more of a connection with psychopaths and therefore see them less negatively. Alternatively, they might see aggressive and violent behaviours as more normal and less distressing compared to other people. This might also explain why participants high in meanness and disinhibition saw psychopaths as non-criminals. For the most part, boldness was unrelated to these attitudes. As I noted earlier, experts agree that meanness and disinhibition are core features of psychopathy, but the relevance of boldness to the concept is more questionable. Meanness was the trait most consistently related to attitudes to psychopathy and boldness was the least. This might suggest that people high in meanness might more readily feel a connection with psychopaths because they more closely resemble psychopaths themselves, whereas this is less true for those who are high in boldness but not necessarily high in the other traits.

Regarding attitudes to our friend Harry the psychopath, boldness had the most consistent effects, as participants high in boldness were less likely to regard him as fearful/violent, more willing to help him in need, and less likely to have negative emotions toward him. Durand et al. argue that because stigma is related to fear, and boldness is related to fearlessness, bolder participants might be less likely to stigmatize psychopaths. Of course, being fearless, they might be less likely to stigmatize people with psychiatric diagnoses in general, so whether this effect is especially relevant to psychopaths is unknown, which the authors acknowledge.

This study suggests that people high in psychopathic traits are to some extent less likely to “stigmatize” psychopaths, in terms of being less likely to regard them as violent and prone to criminality. The authors of the study seem to argue that this is a correct attitude to take. However, I think that they are wrong. Consider their statement that “a growing body of evidence suggests that psychopathy is not strongly linked to increased violence and criminal behavior.” One of the references they cite to support this is Berg et al. (2013), which makes a comparable statement that “psychopathy is a modest risk factor for future violence and criminal recidivism” and that “most psychopaths have no history of serious physical aggression.” This contradicts a vast body of research evidence that psychopathy is robustly linked with violence and criminal offending. Berg et al. cite two references in support of their statement (Salekin Randall, Rogers, & Sewell Kenneth, 1996; Singh & Fazel, 2010) – neither of these describes psychopathy as a “modest” risk factor. In fact, the effect sizes in these studies were statistically large. Furthermore, psychopathy has been described elsewhere as “a reliable predictor of violence across varied populations,” and “the relationship between psychopathy and violence is well established” (Walsh, Swogger, Walsh, & Kosson, 2007). Of course, this does not mean that every person diagnosed as a psychopath is violent; it does mean that, other things being equal, psychopaths have a reliably higher risk for violence.

Durand et al. argue that psychopathy has adaptive aspects, and Berg et al. make similar arguments, stating, “Growing evidence even suggests that a nontrivial minority of psychopaths function with reasonable success in society, free of serious criminal behavior.” Despite their assertion that there is “growing evidence,” the empirical research on this topic provides scant reason to believe this. Several studies have tried to demonstrate the existence of “successful psychopaths” (Hall & Benning, 2006) but such individuals remain elusive. Hall and Benning cite several studies that attempted to identify “noncriminal” psychopaths from community samples to determine whether their psychopathic traits had adaptive features. A consistent pattern that emerged was that so-called noncriminal psychopaths had elevated rates of antisocial behaviours, including physical aggression, and that the majority had been arrested multiple times. In one of the studies cited, more than half had been incarcerated at least once. Their findings suggested that the difference between so-called noncriminal psychopaths and their counterparts in prison was largely that the former had so far managed to avoid being convicted rather than being “free of serious criminal behavior.” However, Hall and Benning go on to argue that “high-functioning, noncriminal psychopaths” might consist of individuals high in fearless dominance but not impulsive antisocial traits. As I pointed out earlier, experts on psychopathy consider impulsive antisocial traits, i.e., meanness and disinhibition, to be at the core of the concept, whereas the relevance of boldness/fearless dominance is disputed. Hence, a person high in fearless dominance but not impulsive antisocial traits would probably be high-functioning and not likely to be a criminal, but it would then be hard to see why they should be considered a psychopath at all.

Regarding Durand et al.’s claims that media and popular culture have fostered public stigmatization of psychopaths by presenting them as ruthless killers, the evidence for this is somewhat mixed. For example, one study examining how media exposure relates to layperson’s understanding of psychopathy, asked participants to assess what traits participants believed a psychopath would possess, using a list of 40 items. Twenty of these items were derived from the Psychopathy Checklist, a valid measure of psychopathy. The remainder were “distractor” traits that are not necessarily indicative of psychopathy. Ten of these were more positive qualities (e.g. intelligent, good at people-reading), while the other were negative traits, including extreme but fairly rare forms of violence, e.g. proneness to murder and torture. Additionally, participants were asked about their exposure to movies and TV shows that feature fictional characters considered to have psychopathic traits. Half of these characters were antagonists (i.e. villains) (e.g. Patrick Bateman, Anton Chigurh) while the other half were protagonists (i.e. central characters in the show) (e.g. Dexter, House). Most participants endorsed some of the negative distractor traits, and more than half endorsed proneness to murder and torture. On the other hand, most of them also endorsed many of the positive distractor traits, and more than half endorsed intelligent, secretive, and good at people-reading. Interestingly, greater exposure to protagonist psychopaths was associated with endorsing more positive than negative distractor items, indicating a positive bias. On the other hand, greater exposure to antagonist psychopaths was not associated with endorsing more negative than positive distractor items, suggesting that negative bias was not related to media exposure. This suggests that media exposure to psychopaths portrayed in a more positive light may have lead people to romanticize them. However, media exposure to psychopaths portrayed in a negative way did not seem to lead to what the authors called “demonization” or what Durand et al. might call stigmatisation.

Other research suggests that although layperson’s have misconceptions about psychopathy, these are not entirely negative. In one study (Smith et al., 2014), potential jurors were asked to think of a “typical psychopath” and rate them on a list of attributes. They were provided no instructions on what it means to be a psychopath. Their attribute ratings were compared with ratings by experts. Jurors showed a mixture of correct and incorrect ratings of psychopaths’ attributes. For example, they rated typical psychopaths as manipulative, lacks remorse, and self-centred, which is in line with expert opinion, but also considered them prone to delusional beliefs, suggesting they may confuse “psychopath” with “psychotic.” Additionally, jurors tended to underrate psychopaths on behavioural (e.g. unreliable, lacking perseverance) and cognitive (e.g.  lacks planfulness, lacks concentration) attributes. This might suggest that laypersons understand that, in terms of big five personality traits, psychopaths tend to be very low in agreeableness but are less aware that they also tend to be low in conscientiousness. Furthermore, juror ratings tended to be less negative than expert ratings, suggesting that laypersons underestimate rather than exaggerate psychopaths’ negative qualities. When asked who they believed to be a typical example of a psychopath, most people indicated famous serial killers or mass murderers. Respondents generally agreed that psychopaths were more violent and more likely to be criminals, but did not think they were generally murderers. Furthermore, respondents did not generally agree that psychopaths are basically evil, that psychopathy is caused by a lack of morals, that they should be treated more harshly than other criminals, or that they should be locked up even if they have not committed a crime. They did agree that psychopaths are responsible for their actions and can tell right from wrong. They agreed rather strongly that “Some psychopaths can avoid getting into trouble with the criminal justice system” and strongly disagreed that “Most psychopaths are in jails or prisons.” Additionally, this study, as well as that by Furnham et al. (2009) found that laypersons (incorrectly) think that psychopaths are above average in intelligence. (I discuss this phenomenon in more detail in a previous post.) These findings do not seem to support the arguments of Durand et al. that psychopaths are a highly stigmatized or even a highly feared group. In fact, they suggest that in some respects, laypersons tend to have a less negative and more positive attitude to psychopaths than is objectively warranted.

Stigma involves lack of “full social acceptance,” and Durand et al. seem to think that this is a problem in relation to people diagnosed as psychopaths. However, sometimes there may be good reasons for denying particular individuals full acceptance into society. This should not be done lightly, but should be a fully informed decision. When considering how psychopaths should be treated in society, it would be wise to consider the moral qualities that define the core of the syndrome. Considering these, it may be quite reasonable that sometimes there are negative consequences associated with being a psychopath. While laypersons may have misconceptions about what psychopaths are like, serious scholars should not respond to these by adding their own misconceptions that play down the negative aspects of this condition.

© Scott McGreal. Please do not reproduce without permission. Brief excerpts may be quoted as long as a link to the original article is provided. 

References

Berg, J. M., Smith, S. F., Watts, A. L., Ammirati, R., Green, S. E., & Lilienfeld, S. O. (2013). Misconceptions regarding psychopathic personality: Implications for clinical practice and research. Neuropsychiatry, 3(63-74). doi:https://doi.org/10.2217/npy.12.69

Durand, G., Plata, E. M., & Arbone, I.-S. (2017). Negative attitudes towards psychopaths: The role of one's own psychopathic traits. Personality and Individual Differences, 109, 72-76. doi:https://doi.org/10.1016/j.paid.2016.12.047

Furnham, A., Daoud, Y., & Swami, V. (2009). “How to spot a psychopath”. Social Psychiatry and Psychiatric Epidemiology, 44(6), 464-472. doi:10.1007/s00127-008-0459-1

Hall, J., & Benning, S. (2006). The “successful” psychopath: Adaptive and subclinical manifestations of psychopathy in the general population. In C. J. Patrick (Ed.), Handbook of psychopathy (pp. 459-478). NY, USA: Guilford Press.

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Salekin Randall, T., Rogers, R., & Sewell Kenneth, W. (1996). A Review and Meta-Analysis of the Psychopathy Checklist and Psychopathy Checklist-Revised: Predictive Validity of Dangerousness. Clinical Psychology: Science and Practice, 3(3), 203-215. doi:10.1111/j.1468-2850.1996.tb00071.x

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