Sociopathy, Antisocial Personality Disorder & Psychopathy

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Hare's PCL-R 20-item checklist is based on Cleckley's 16-item checklist, and the following is a discussion of the concepts in the PCL-R.

But first of all, here is Cleckley's original list of symptoms of a psychopath:

1. Considerable superficial charm and average or above average intelligence.

2. Absence of delusions and other signs of irrational thinking

3. Absence of anxiety or other "neurotic" symptoms considerable poise, calmness, and verbal facility.

4. Unreliability, disregard for obligations no sense of responsibility, in matters of little and great import.

5. Untruthfulness and insincerity

7. Antisocial behavior which is inadequately motivated and poorly planned, seeming to stem from an inexplicable impulsiveness.

7. Inadequately motivated antisocial behavior

8. Poor judgment and failure to learn from experience

9. Pathological egocentricity. Total self-centeredness incapacity for real love and attachment.

10. General poverty ot deep and lasting emotions.

11. Lack of any true insight, inability to see oneself as others do.

12. Ingratitude for any special considerations, kindness, and trust.

13. Fantastic and objectionable behavior, after drinking and sometimes even when not drinking--vulgarity, rudeness, quick mood shifts, pranks.

14. No history of genuine suicide attempts.

15. An impersonal, trivial, and poorly integrated sex life. (i.e. casual sex, sex for sex's sake, no real emotional intimacy)

16. Failure to have a life plan and to live in any ordered way, unless it be one promoting self-defeat.

"...More often than not, the typical psychopath will seem particularly agreeable and make a distinctly positive impression when he is first encountered. Alert and friendly in his attitude, he is easy to talk with and seems to have a good many genuine interests. There is nothing at all odd or queer about him, and in every respect he tends to embody the concept of a well-adjusted, happy person. Nor does he, on the other hand, seem to be artificially exerting himself like one who is covering up or who wants to sell you a bill of goods. He would seldom be confused with the professional backslapper or someone who is trying to ingratiate himself for a concealed purpose. Signs of affectation or excessive affability are not characteristic. He looks like the real thing.

"Very often indications of good sense and sound reasoning will emerge, and one is likely to feel soon after meeting him that this normal and pleasant person is also one with -high abilities. Psychometric tests also very frequently show him of superior intelligence. More than the average person, he is likely to seem free from social or emotional impediments, from the minor distortions, peculiarities, and awkwardnesses so common even among the successful. Such superficial characteristics are not universal in this group but they are very common..."

"...It must be granted of course that the psychopath has some affect. Affect is, perhaps, a component in the sum of life reactions even in the unicellular protoplasmic entity. Certainly in all mammals it is obvious. The relatively petty states of pleasure, vexation, and animosity experienced by the psychopath have been mentioned. The opinion here maintained is that he fails to know all those more serious and deeply moving affective states which make up the tragedy and triumph of ordinary life, of life at the level of important human experience..."

Hare's Checklist

1. GLIB and SUPERFICIAL CHARM -- the tendency to be smooth, engaging, charming, slick, and verbally facile. Psychopathic charm is not in the least shy, self-conscious, or afraid to say anything. A psychopath never gets tongue-tied. They have freed themselves from the social conventions about taking turns in talking, for example.

2. GRANDIOSE SELF-WORTH -- a grossly inflated view of one's abilities and self-worth, self-assured, opinionated, cocky, a braggart. Psychopaths are arrogant people who believe they are superior human beings.

3. NEED FOR STIMULATION or PRONENESS TO BOREDOM -- an excessive need for novel, thrilling, and exciting stimulation; taking chances and doing things that are risky. Psychopaths often have a low self-discipline in carrying tasks through to completion because they get bored easily. They fail to work at the same job for any length of time, for example, or to finish tasks that they consider dull or routine.

4. PATHOLOGICAL LYING -- can be moderate or high; in moderate form, they will be shrewd, crafty, cunning, sly, and clever; in extreme form, they will be deceptive, deceitful, underhanded, unscrupulous, manipulative, and dishonest.

5. CONNING AND MANIPULATIVENESS- the use of deceit and deception to cheat, con, or defraud others for personal gain; distinguished from Item #4 in the degree to which exploitation and callous ruthlessness is present, as reflected in a lack of concern for the feelings and suffering of one's victims.

6. LACK OF REMORSE OR GUILT -- a lack of feelings or concern for the losses, pain, and suffering of victims; a tendency to be unconcerned, dispassionate, coldhearted, and unempathic. This item is usually demonstrated by a disdain for one's victims. (can focus on THEIR losses but usually blame others for the results of their actions)
7. SHALLOW AFFECT -- emotional poverty or a limited range or depth of feelings; interpersonal coldness in spite of signs of open gregariousness.

8. CALLOUSNESS and LACK OF EMPATHY -- a lack of feelings toward people in general; cold, contemptuous, inconsiderate, and tactless.

9. PARASITIC LIFESTYLE -- an intentional, manipulative, selfish, and exploitative financial dependence on others as reflected in a lack of motivation, low self-discipline, and inability to begin or complete responsibilities.

10. POOR BEHAVIORAL CONTROLS -- expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper; acting hastily.

11. PROMISCUOUS SEXUAL BEHAVIOR -- a variety of brief, superficial relations, numerous affairs, and an indiscriminate selection of sexual partners (prostitutes or people they barely know); the maintenance of several relationships at the same time; a history of attempts to sexually coerce others into sexual activity or taking great pride at discussing sexual exploits or conquests.

12. EARLY BEHAVIOR PROBLEMS -- a variety of behaviors prior to age 13, including lying, theft, cheating, vandalism, bullying, sexual activity, fire-setting, glue-sniffing, alcohol use, and running away from home.

13. LACK OF REALISTIC, LONG-TERM GOALS -- an inability or persistent failure to develop and execute long-term plans and goals; a nomadic existence, aimless, lacking direction in life.

14. IMPULSIVITY -- the occurrence of behaviors that are unpremeditated and lack reflection or planning; inability to resist temptation, frustrations, and urges; a lack of deliberation without considering the consequences; foolhardy, rash, unpredictable, erratic, and reckless.

15. IRRESPONSIBILITY -- repeated failure to fulfill or honor obligations and commitments; such as not paying bills, defaulting on loans, performing sloppy work, being absent or late to work, failing to honor contractual agreements.

16. FAILURE TO ACCEPT RESPONSIBILITY FOR OWN ACTIONS -- a failure to accept responsibility for one's actions reflected in low conscientiousness, an absence of dutifulness, antagonistic manipulation, denial of responsibility, and an effort to manipulate others through this denial.

17. MANY SHORT-TERM MARITAL RELATIONSHIPS -- a lack of commitment to a long-term relationship reflected in inconsistent, undependable, and unreliable commitments in life, including marital.

18. JUVENILE DELINQUENCY -- behavior problems between the ages of 13-18; mostly behaviors that are crimes or clearly involve aspects of antagonism, exploitation, aggression, manipulation, or a callous, ruthless tough-mindedness.

19. REVOCATION OF CONDITION RELEASE -- a revocation of probation or other conditional release due to technical violations, such as carelessness, low deliberation, or failing to appear.

20. CRIMINAL VERSATILITY -- a diversity of types of criminal offenses, regardless if the person has been arrested or convicted for them; taking great pride at getting away with crimes.

What Causes Antisocial Personality Disorder?
Donald W. Black, M.D.

The cause of antisocial personality disorder, or ASP, is unknown. Like many mental health issues, evidence points to inherited traits. Like father, like son. But dysfunctional family life also increases the likelihood of ASP. So although ASP may have a hereditary basis, environmental factors contribute to its development.

The TheoriesResearchers have their own ideas about ASP's cause. One theory suggests that abnormalities in development of the nervous system may cause ASP. Abnormalities that suggest abnormal nervous system development include learning disorders, persistent bedwetting and hyperactivity.

A recent study showed that if mothers smoked during pregnancy, their offspring were at risk of developing antisocial behavior. This suggests that smoking brought about lowered oxygen levels with may have resulted in subtle brain injury to the fetus.

Yet another theory suggests that people with ASP require greater sensory input for normal brain function. Evidence that antisocials have low resting pulse rates and low skin conductance, and show decreased amplitude on certain brain measures supports this theory. Individuals with chronically low arousal may seek out potentially dangerous or risky situations to raise their arousal to more optimal levels to satisfy their craving for excitement.
Brain imaging studies have also suggested that abnormal brain function is a cause of antisocial behavior. Likewise, the neurotransmitter serotonin has been linked with impulsive and aggressive behavior. Both the temporal lobes and the prefrontal cortex help regulate mood and behavior. It could be that impulsive or poorly controlled behavior stems from a functional abnormality in serotonin levels or in these brain regions.

The Environment
Social and home environment also contributes to the development of antisocial behavior. Parents of troubled children frequently show a high level of antisocial behavior themselves. In one large study, the parents of delinquent boys were more often alcoholic or criminal, and their homes were frequently disrupted by divorce, separation or the absence of a parent.

In the case of foster care and adoption, depriving a young child of a significant emotional bond could damage his ability to form intimate and trusting relationships, which may explain why some adopted children are prone to develop ASP. As young children, they may be more likely to move from one caregiver to another before a final adoption, thereby failing to develop appropriate or sustaining emotional attachments to adult figures.

Erratic or inappropriate discipline and inadequate supervision have been linked to antisocial behavior in children. Involved parents tend to monitor their child's behavior, setting rules and seeing that they are obeyed, checking on the child's whereabouts, and steering them away from troubled playmates. Good supervision is less likely in broken homes because parents may not be available, and antisocial parents often lack the motivation to keep an eye on their children. The importance of parental supervision is also underscored when antisocials grow up in large families where each child gets proportionately less attention.

A child who grows up in a disturbed home may enter the adult world emotionally injured. Without having developed strong bonds, he is self-absorbed and indifferent to others. The lack of consistent discipline results in little regard for rules and delayed gratification. He lacks appropriate role models and learns to use aggression to solve disputes. He fails to develop empathy and concern for those around him.

Antisocial children tend to choose similar children as playmates. This association pattern usually develops during the elementary school years, when peer group acceptance and the need to belong first become important. Aggressive children are the most likely to be rejected by their peers, and this rejection drives social outcasts to form bonds with one another. These relationships can encourage and reward aggression and other antisocial behavior. These associations may later lead to gang membership.

Child abuse has also been linked with antisocial behavior. People with ASP are more likely than others to have been abused as children. This is not surprising since many of them grow up with neglectful and sometimes violent antisocial parents. In many cases, abuse becomes a learned behavior that formerly abused adults perpetuate with their own children.

It has been argued that early abuse (such as vigorously shaking a child) is particularly harmful, because it can result in brain injury. Traumatic events can disrupt normal development of the central nervous system -- a process that continues through the adolescent years. By triggering a release of hormones and other brain chemicals, stressful events could alter the pattern of normal development.