Psychopathy was the first personality disorder to be recognized in psychiatry and yet it is not even included in the DSM-IV, the official diagnostic manual used by psychiatrists in North America. It is an important concept in forensic psychiatry and the criminal justice system.
It overlaps with, but is not identical to, antisocial personality disorder which is included in the DSM-IV. Most people with antisocial personality disorder are not psychopathic, whereas most people who are psychopathic would also meet diagnostic criteria for antisocial personality disorder. The prevalence of antisocial personality disorder is at least 3 times that of psychopathy. People with psychopathy are grandiose, deceptive, dominant, superficial, and manipulative. They are shallow, unable to form strong emotional bonds with others, and lack empathy, guilt or remorse.
It is not surprising that psychopathy is important in criminal behaviour since many of the characteristics important for inhibiting antisocial and violent behaviour—empathy, close emotional bonds, fear of punishment, guilt—are lacking in psychopathic people. They find it easy to victimize the vulnerable and to use intimidation and violence as tools to achieve power and control over others. They are predatory, premeditated and cold-blooded.
Psychopathy is a well established risk factor for recidivism. This applies to adult male and female offenders, adolescent offenders, forensic psychiatric patients and offenders with intellectual difficulties. It is also an important factor in explaining many cases of domestic violence.
Psychopathic sex offenders are likely to be more violent and more sadistic than those of other sex offenders. They are more likely to engage in sexual homicide and to use more gratuitous and sadistic violence.
In view of this it is perhaps surprising that psychopathic sex offenders are more likely to obtain early release from prison than are other sex offenders, because they are good at impression management.
Because they suffer little personal distress and see nothing wrong with their attitudes and behaviour, psychopaths are difficult to treat. They tend to seek treatment only when it is in their best interest to do so, such as when they are seeking probation or parole. Not surprisingly, they derive little benefit from treatment programs that are emotion-based, insight oriented or aimed at developing empathy or conscience.
Some have proposed that treatment should instead be aimed at teaching psychopaths that there are more prosocial ways of using their strengths and abilities to satisfy their needs and desires. There is, however, not very good evidence that any treatment is terribly effective with psychopaths.
We see examples of the crimes committed by these people almost every day in the media—acts of extreme cruelty, heartless, cold-blooded acts of violence to others, victimization of the defenceless and vulnerable. We wonder how or why anyone would do such things. They are very different from you or me. They march to a different drummer. It does no good to appeal to empathy, conscience or sense of fair play.