What is a Psychopath? The Traits and Brains of Psychos

“She showed him a picture of a frightened face and asked him to identify the emotion. He said he didn’t know what the emotion was, but it was the face that people pulled just before he killed them.” (The Psychopath Test)

This is the idea we have in our head of psychopaths, the Jeffery Dahmers of the world. But what if I told you that psychopaths are just another version of normal, people with a brain condition they cannot control?

This is not an incredibly popular stance to take. Detective Petrosky would probably punch me in the face for it, and with good reason: as a society we are taught that psychopaths are dangerous individuals. This is not generally the case. You have almost certainly met a few in your life, and at least some of them slipped under your radar with no harm to those in the vicinity.

Not that it’s your fault for being unaware; those with psychopathic personalities don’t show many obvious signs. They don’t hear voices, they don’t talk to themselves, they don’t seem nervous. Plus, not everyone with psychopathic traits is a true balls-to-the-wall psychopath, though many do display behaviors that create conflict or risk, particularly in relationships.

That’s right, balls-to-the-wall. It’s a clinical term.

Let’s be clear up front: the partners of psychopaths tend to suffer. The children of psychopaths also suffer at higher rates due to the necessity of strong empathy in the early years (Check out Wicked Sharp, the first novel in the Born Bad series for an up-close look at that phenomenon in action). I have also treated women whose psychopathic partners murdered their children for fun. Those with violent tendencies on top of psychopathy do have the potential to be extremely dangerous, making swift intervention a necessity to avoid catastrophe. This is not to diminish these facts nor is it to diminish the experiences of those who have suffered at the hands of someone with this condition. (However, it is also important to note that in most cases, the “psycho ex” is more likely to be something besides an actual psychopath.)

It is also worth noting that I have some first-hand experience outside the clinical realm. But, because of my work, I know what psychopathy looks like when I see it, though I tend to feel it before I register it logically.

Just before my first child was born a mild-mannered neighbor (let’s call him “Jack”) knocked on my door. He begged me to come to his home to, “Help my roommate. She’s depressed, and I think she might hurt herself.” By this time I was in full fight-flight mode. His eyes made me want to run.

I encouraged him to call nine-one-one. He turned and studied our other neighbor who was working in the front yard. When the man waved, Jack backed up and headed home without another word.

I dead-bolted the door and threw up in the sink. My heart rate was high for days. I obsessed about locking doors. My husband thought I had lost my mind.

Soon after, I found out that Jack’s roommate was officially missing, though exactly when she disappeared remained elusive. A week after that they found her torso in a nearby lake, though they never found the rest of her body. Jack was arrested a month later. Apparently, I didn’t have enough to deal with at work.

Despite the existence of these types of stories, I stick by my claim that, as opposed to a condition of murderous rage, psychopathology is more a pattern of personality and thoughts that have a wide range of symptoms, and it is specific traits in addition to the psychopathy that lead to violence. And despite some areas of difficulty, those with psychopathic tendencies also have a number of strengths, strengths which have benefited the human race since the beginning of time.

The benefits of psychopaths?

Damn straight. Things are never as clear cut as they seem. In addition, because of the nature of those strengths, we may actually be breeding individuals who are less empathic with each subsequent generation by default. We may also contribute to this issue further by glorifying school shooters or making martyrs of those psychopathic individuals who actually become violent by offering them fame and immortality should they manage to pull off a crime just heinous enough.

We think we hate psychopaths. But as a nation, we love them at the very same time and encourage the very traits that frighten us.

Let’s take a ride.

The Controversy Over Psychopathology

The terms “psychopath” and “sociopath” are often used interchangeably, though they have both recently received their own space as specifiers in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) under the official diagnosis of Antisocial Personality Disorder (which is not to be confused with introversion). Antisocial DOES NOT MEAN “against socializing.” So stop with the memes, Buzzfeed, you look like a tool. Now that I’ve gotten that off my chest:

Antisocial Personality Disorder is a pattern of disregard for others, occurring from the age of fifteen, that includes at least three of the following:

• Failure to conform to social norms

• Irresponsible behaviors

• Deceitfulness

• Indifference to the feelings/wellbeing of others

• Recklessness

• Trouble planning ahead

• Aggressiveness or irritability

Antisocial Personality Disorder was developed as a way to measure overt symptoms or behaviors, because there was some dissent about whether shrinks could reliably measure the personality traits inherent in psychopathy.

How can you measure how charming someone is? Is there a Rico Suave scale?

For those who believe it is possible, and that psychopathy is its own unique disorder, Hare’s Checklist, or the Psychopathy Checklist Revised (PCL-R), is the most common tool used to measure how many psychopathic traits one has. Each of twenty areas is scored on a scale from 0 to 2. A score of 25-30 is the norm to be considered psychopathic.

The Hare PCL-R Checklist for Psychopathy includes the following:

• Glibness/superficial charm

• Grandiose sense of self worth

• Need for stimulation/prone to boredom

• Pathological lying

• Conning/manipulation

• Lack of remorse or guilt

• Shallow Affect (does not show emotions, or shows very little)

• Callous/lack of empathy

• Parasitic lifestyle

• Poor behavioral controls

• Promiscuous sexual behavior

• Early behavior problems

• Lack of realistic long term goals

• Impulsivity

• Irresponsibility

• Failure to accept responsibility for own actions

• Many short-term marital relationships

• Juvenile delinquency

• Revocation of conditional release (or being hauled back to jail or a juvenile detention center after reoffending)

• Criminal versatility

If you are currently scoring yourself on these areas, knock it off. Not only is it difficult to rate your own behaviors, but if the thought of being a psychopath upsets you enough to try to self-diagnose, rest assured you are not a psycho.

But a lot of people are. Psychopathy is estimated to be present in approximately one percent of females and three percent of males (or two percent of the global population). I have treated a number of psychopathic and borderline psychopathic individuals, both inpatient and out, and there are a wide range of issues and severity just like any other population. Some displayed problem or criminal behaviors, some harmed others in completely legal and revered ways, say during times of war, or as a member of the police force. Very rarely, they came to me in private practice, charismatic and calm (eight out of ten on the Rico Suave scale). However, their reasons for showing up were more about convenience or interest and had nothing to do with being stressed or feeling badly that they had hurt a partner physically or emotionally. This lack of love or empathy is a difficult hurdle to get past, and indeed, many of the other behaviors inherent in this condition stem from the incapacity to feel for others.

Cognitive Empathy Versus Emotional Empathy

Emotional empathy is the response most are familiar with, an ability to feel what others feel, an emotion that connects people. Cognitive empathy is knowing how another person feels and what they might be thinking, but without the burden of actual feelings, moral implications, or social connectedness.

Let’s be honest, we all wish we could turn off our feelings sometimes. They can be a bigger pain in the ass than sitting on a Lego. If you’ve never done this, I don’t recommend it. Take it from someone currently sitting on a pool inner tube. But I digress.

Often, psychopaths are unaware that they don’t feel things the way others do. Just as we are not upset that we lack the excessive smelling ability of a dog, those without fear or empathy don’t know there is something there to miss. (Unlike that Lego thing which none of us can ignore.)

But what exactly would trigger this type of disconnect in the brain of someone with a psychopathic personality?

Psychopathic Tendencies and the “Theory of Mind”

Neuroscientist and self-proclaimed “borderline psychopath,” Dr. James Fallon, notes that empathic function and social understanding can be broken down using what he calls the “Theory of Mind” in his book The Psychopath Inside. Theory of mind is what allows humans—with our more developed medial prefrontal system—to consider the thoughts of others, a necessary ingredient in empathy.

By way of further explanation, Fallon notes that those with autism maintain empathy but lack this theory of mind consideration for the differing thoughts of others, i.e., they are able to feel deeply, but have trouble recognizing how others feel. In contrast, psychopaths lack the empathy while retaining the theory of mind, so they may not feel anything themselves, but are able to guess what others are thinking or feeling.

And psychopaths tend to be very adept at picking up on the signals of others, including vulnerability, because they are not influenced by their own emotional input. It is a practiced skill, one that does not necessarily affect those around them negatively, but can depending on how the information is used.

It might not matter if your mother-in-law knows you hate crafts, so long as she doesn’t use that information to engage the kids in a full-on glitter extravaganza just so she can feign innocence at your husband when you come home. “Your wife is always so MEAN to me. Why do you let her talk to me like that? I’m your mother! And also, you really need to visit more.”

It’s not the knowledge that matters. It’s the exploitation.

But Fallon notes that even without empathy, sympathy can still be present. While empathy requires imagining what someone else feels and often feeling it yourself, sympathy only requires noticing that something is bothering another and having a desire to assist them, even if the reasons for such assistance further your own goals.

It is this sympathy, along with personal goals, that may allow those close to a psychopath to remain in their favor, while all others are disregarded. As Fallon says, even dictators or terrorists may express high regard for their people or their religion, and seek revenge for slights on behalf of those they care for. However, for most, it is easier to assume “craziness” than sympathy as a trigger for inhumane violence.

But the differences in the brain of a psychopath go beyond simple empathic considerations. There are also changes in actual brain matter which trigger the other symptoms associated with psychopathy.

The Brain and Psychopathy

Fallon found low function or physical damage to these areas of the brain:

• The Prefrontal Cortex (a part called the anterior cingulate) which deals with the control of impulses, antisocial behaviors and obsessiveness

• The Orbital Cortex and Ventromedial Prefrontal Cortex: an area involved in morality, socialization and influence inhibition

• The Temporal Lobe: involved in auditory perception, long-term memory and emotional response

• The Amygdala: the emotion processing center. In an interview by Ron Ronson in The Psychopath Test, Bob Hare notes that psychopaths have issues in the amygdala where signals of fear don’t translate to the central nervous system correctly. For example, fear responses aren’t present when faced with electric shocks, and these individuals seem to forget the pain after the initial shocks, as if the memory was not recorded properly (possibly due to alterations in the temporal lobe as well). This may make fear of future reprisal and consequences less helpful in dissuading behaviors.

• Connector strips between orbital, cingulate and temporal cortex (insula): These areas make up a major chunk of the brain’s emotional regulation centers. In psychopathy, there is a widespread alteration in function not present in other impulsive disorders.

• The Dorsal Prefrontal Cortex: interprets any conflict between internal drives and social context and makes decisions.

Those with psychopathy also tend to have changes to dopamine systems. Dopamine flips switches into action to trigger the body to do things (without this trigger, all the motivation in the world won’t make you get off a couch). It does not decide what happens, but rather how fast and aggressively it does. It can’t make you decide to get the ice cream, but it can help you leap from the couch and run for the freezer. And those with psychopathy may have greater dopamine release in the brain which primes them to more aggressively seek rewards even as higher amounts of stimulation are needed in order to get satisfaction.

Ruh roh.

But while psychopaths may have less functioning in “hot cognition” or emotional response regions of the brain, the cold cognition and planning functions remain present and perhaps finely tuned in the absence of emotional input. And this is one of the elements of psychopathy that may have been beneficial to us historically. In fact, many of the traits in psychopathy may have a positive edge to them, particularly in capitalist societies or those that value (or necessitate) risk-taking or callous demeanors.

But when crossing the line from successful to harmful is easy (heck, even non-psychopathic individuals do it) there are significant risks to the general populace. Most people are pretty sure they’re living in a “kill or be killed” world, it’s just that most of us have some safeguards (like guilt or revulsion or fear of jail) to prevent us from tearing out the neighbor’s spleen. And it’s especially hard to tell who’s a psychopath and who isn’t when men are encouraged to be emotionless drones as opposed to full humans with all the applicable feelings (which is incredibly unfair to them). Boys are especially susceptible to the idea that “presenting as a psycho is better than letting them see you cry”–I have a whole story devoted to it.

Violence is not always physical. And in the game of building a better psychopath, we’re off to a fantastic start. That particular phenomenon deserves a post all its own–learn more in “Breeding Psychopaths and the Future of Humanity.”