Five Myths About Psychopaths

As part of my summer reading, I have become reacquainted with some of the literature in abnormal psychology. In particular, I have found The Psychopath Whisperer by Kent Kiehl (2014) very insightful. Kiehl is one of the most prominent researchers in psychopathy and pioneered much of the work that has enabled scholars to better understand the neuroscience behind this condition.

There are a number of myths that pervade pop culture regarding psychopaths. Here is my take on some of the most common misunderstandings regarding this condition:

1. Psychopathy is the same thing as having an anti-social personality disorder.

I will admit, I didn’t realize that technically the DSM doesn’t recognize psychopathy as a diagnosable clinical condition until I read this book. This is because the DSM diagnosis of the anti-social personality is oftentimes equated with psychopathy. While there are similarities between the two, they are actually different conditions, and psychopathy is assessed using distinct criteria that has been well-tested and legitimized—unlike the criteria for personality disorders in the DSM that have been questioned both on reliability and validity grounds.

In fact, Kiehl identifies that, “Without proper training, the average clinician will likely have trouble producing valid ratings of psychopathy” (p. 47). Indeed, it is not uncommon for forensic practitioners to believe that the DSM criteria for this personality disorder also identifies psychopathy, but this is in fact not the case. The numbers suggest about one-third of patients who are diagnosed with this personality disorder also meet the criteria for psychopathy, so while there are critical overlaps, they remain distinct conditions. This distinction highlights the limitations of the DSM, one of them being that the affective features of psychopathy are not easily identified or addressed via a diagnosis of an anti-social personality disorder.

2. Psychopathy is the same thing as being a sociopath.

In a lot of ways, this myth is an extension of the first one, as in the same way popular culture portrays the anti-social personality as synonymous with psychopathy, the term sociopath is often similarly used to denote psychopathy. In fact, "sociopathy" is not really used in the clinical community anymore. Its inception derived from an attempt to distinguish psychopathy, which was believed to be grounded in nature or biology, by identifying that psychopathic traits could derive from social causes.

However, as Kiehl notes, “Sociopathy includes a broad, heterogenous category of individuals who act antisocially, the causes of which are believed to be social and environmental in nature” (p. 40-41). Moreover, he goes on to conclude this passage by noting that the term is no longer used in academic circles today and that there doesn’t appear to be any diagnostic criteria associated with it as a specific condition. Indeed, it appears that the term remains as a byproduct of an earlier era in the field, and most often is used erroneously as a stand-in for psychopathy.

3. Mass shooters are psychopaths.

Perhaps no other myth is most resonant and dangerous, given the cultural context of mass violence at this moment in time. While it is tempting to claim that shooters who engage in mass violence are psychopaths, this is wildly inaccurate. While psychopaths are over-represented in the criminal population, the majority of mass shooters are not violent because of an underlying mental illness but because of other, more predictable elements of mass violence such as: access to guns, a sense of entitlement, radicalization online, etc. For instance, despite the common rhetoric corporate media transmits in the aftermath of mass violence, the research suggests that less than 4 percent of mass shooters meet the diagnostic criteria for any mental illness (refer to my previous post for resources).

Psychopathy does predict recidivism for former inmates—in fact, inmates who score high on this measure are four to eight times more likely to recidivate than inmates with lower scores (Kiehl, 2014). However, the crimes that they engage in, while oftentimes violent, are not the types of mass violence that we regularly see with these mass shootings. In fact, “most individuals who commit killing sprees do not meet criteria for psychopathy” (Kiehl, 2014, p. 201). Mass shootings are a symptom of a different problem in our culture, not a demonstration of psychopathy per se.

4. Psychopaths cannot be effectively treated.

In psychopathy, as in antisocial personality disorder, patients oftentimes do not respond well to treatment. Indeed, in the case of psychopathy, the research suggests that punishment or threat of punishment does not work as an effective deterrent or behavior modification strategy. Moreover, some evidence actually suggests that group therapy may enhance likelihood of problematic behaviors for psychopaths versus no treatment at all.

This does not mean, however, that the condition is entirely irreversible. Kiehl has pioneered groundbreaking work regarding deficits in certain systems within the brain for individuals who show signs of psychopathy. This has huge implications for therapy, especially in lieu of groundbreaking work in neuroscience that has identified the adaptability of the brain.

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Is it possible that deficits in the psychopathic brain can be rewired with early intervention? In fact, Kiehl details a groundbreaking treatment approach pioneered by the Mendota Juvenile Treatment Center in Wisconsin that utilizes intensive, one-on-one cognitive behavioral therapy for youth with elevated psychopathy traits. The intervention was shown to effectively reduce not only violent crime rates among participants but even the severity of the type of crimes committed. The Center continues to treat some of the state’s most violent youth offenders and is considered successful. Unfortunately, its model for treatment of at-risk youth has not been adopted widely across the country.

5. Early problems in childhood indicate psychopathy.

Generally speaking, clinicians do not and should not use the word psychopath to describe a young patient, as the term is highly loaded, and a child who is still developing can start to conform to the label if referred to in such a way.

This isn’t to say that there aren’t risk factors in youth that can indicate psychopathy, but to caution against rushing to judgment. In fact, “Scientists have shown that disruptive and antisocial behavior peaks in adolescence” (Kiehl, 2014, p. 184). However, in the majority of cases in which there is difficulty during this developmental stage, psychopathy is not behind the problems that a youth may be experiencing. Even a disruptive disorder that may appear to be a “red flag” may not be as predictive as it seems.

For instance, “Nearly 80 percent of children diagnosed with conduct disorder grow out of it and do not develop an adult personality disorder, or psychopathy” (Kiehl, 2014, p. 141). This isn’t to say that it isn’t important to be able to identify risk factors for psychopathy in early development but to caution against drawing on stereotypes or assumptions where problematic behavior is immediately deemed "psychopathy" among youth.

In fact, Kiehl identifies a very tragic case of a young man being told he is a psychopath by a clinician and then conforming to the label by engaging in psychopathic behaviors. Alas, when Kiehl gets an opportunity to study this developing boy, he uncovers that not only does he not score high on the assessment of psychopathy, but that much of his problematic behavior, in fact, stemmed from a self-fulfilling prophecy after hearing a person in a position of authority labeling him in such a stigmatizing way. Kiehl identifies an important triad of risk factors in early development that more accurately predicts adult psychopathy—bed-wetting, fire starting, and cruelty towards animals.

In sum, for those of you interested in learning more about the complexity of the condition of psychopathy, consider reading Kiehl’s 2014 book in its entirety. It's critical to note that we must stay vigilant in separating fact from fiction when it comes to a condition such as psychopathy, particularly in this cultural moment when it is so tempting to look around us and wonder if our entire nation is suffering from this condition. It's also worth pointing out that individuals can—and often do—engage in reprehensible or anti-social behaviors without having any underlying disorder or disease.

Copyright 2019 Azadeh Aalai