Is psychopathy a disease?

Psychopathy has always been a fascination. That is why characters with their own characteristics have starred in many works in fiction, some of them widely awarded.

These are individuals who have been portrayed as evil beings, capable of the most disturbing acts and shrouded in a halo of mystery. But does this stereotype fit the reality of the problem?

In this article we will reflect on the question and answer a very frequently asked question: is psychopathy a disease?

• Recommended article: "Psychopathy: what happens in the psychopath's mind?"

To do this, it is essential to first descend where it lives, to define it and draw a line that differentiates psychopaths from other people.

What is psychopathy: ten essential traits

Below we present the most common features of this phenomenon, through which we can answer the question posed: Is psychopathy a disease?

The points to be addressed describe the ways of thinking, feeling and acting of these people; although they do not always appear in all cases.

1. Difficulty learning from the past

People with psychopathy have great difficulty learning from the events they experienced in the past and that they did some damage to them. For this reason, despite the fact that they are penalized for carrying out conduct that violates the rights of others, the punishment imposed on them does not exert any deterrent effect on them. Thus, they tend to maintain their conduct despite the efforts of the judges to impose severe penalties for their crimes.

This feature has been the subject of controversy many times, as it questions one of the basic pillars of the judicial system: the reintegration of people who commit illegal acts. This is an argument frequently used to defend the use of harsher measures for those criminals who commit especially gruesome acts.

2. Low liability

People with psychopathy often have a low sense of responsibility, so they may be unable to keep their job or studies long enough to progress. Also contributing to this is a certain need for stimulation and a substantial facility for boredom.

This trait also has, as a counterpart, the tendency to attribute to others the blame of all setbacks and vicissitudes that they may experience (which undermines the emotional state of those who are around).

3. Utilitarian view of relationships

One of the most basic characteristics of psychopathy is the pragmatic view of social relations, which implies that they are perceived as a means to satisfy their needs. Therefore, they can make an effort to maintain a bond as long as it brings them some personal benefit, losing interest when this progresses to a point where a certain reciprocity is required or the deliberate imbalance to which they aspire.

This fact is enhanced by the particular profile of these people with regard to empathy. Specifically, there is a deficit in emotional empathy (ability to feel identified in the pain of others and to have compassion), but a total preservation of its cognitive dimensions (ability to infer the internal states of others and to foresee their conduct). They can, therefore, make use of this knowledge in their own interest (manipulation, lying, etc.).

4. Impulse control problems

People with psychopathy have marked difficulty controlling impulses, that is, to inhibit a behavior that may have adverse implications (for them or for others). This inability (along with intolerance to frustration) makes it difficult to manage emotions in the face of situations in which a goal that they consider important is impeded, facilitating the outbreak of violent acts or dangerous.

The most frequent risk behaviors in these subjects would be: risky sexual encounters, substance use, search for extreme sensations or fights. This is one of the reasons why comorbid mental disorders can appear, especially drug dependence.

5. Superficial charm

People with psychopathy can be attractive in short distances and in contacts that do not involve depth, such as exchanges that take place in the academic or work context. These are individuals who are described many times as charming, caring, and polite; so when they commit a reprehensible act, the social environment tends to be surprised or even upset.

This social mask is often used because it is the one that increases the probability of interacting with others in a profitable way. However, if relationships go deeper, it is difficult to maintain it. This fact would explain why those closest to them highlight for them a series of traits that differ, or even they diametrically oppose those used by people whose relationship with the psychopath is merely superficial.

6. Antisocial behaviors

Antisocial behavior is very common among psychopaths. It includes acts that generate some damage for third parties in the economic, mental, physical or moral spheres; and that can be summarized as brawls, robberies, destruction, abuse, harassment, fraud, threat or other expressions of interpersonal violence. However, there is a high percentage of these people who never incur them, so they are fully integrated into society.

The DSM5 manual includes antisocial personality disorder as the closest diagnosis to psychopathy (based mainly on the commission of crimes from an early age), but does not have specific criteria for the latter. This form of classification is the subject of much criticism, since not all psychopaths carry out criminal acts in their life.

7. Strong aggressiveness

People with psychopathy can show very aggressive behaviors, in the broad sense of the term. These are not limited only to their physical dimension, but can also adopt a covert and insidious expression (hostility), especially when their purposes are impeded. This aggressiveness is perceived by the person who receives it as excessive, and includes sudden outbursts of anger that seem unstoppable.

8. Inability to experience guilt

Psychopaths have a hard time feeling remorse for their actions. Guilt is a feeling that arises when we do something that is detrimental to third parties, and that is accentuates by attributing voluntariness or by perceiving that the possible alternatives of action. It is a painful and unpleasant experience for most of the population, and it reduces the probability that in future occasions we will choose to repeat the behavior that motivated it.

Thus, guilt allows us to learn from past mistakes and is connected with empathy. It is one of the main reasons why psychopaths are insensitive to punishment, since they perceive it as an injustice that deserves a rebellion. It is a way of processing information in which liability is excluded from the equation that attempts to explain reality.

There are many experimental studies that indicate that people with psychopathy show low electrodermal reactivity to scenes of violence. This means that, when they are exposed to images in front of which a majority of people refer an aversive emotion (mutilations, aggressions, abuse, etc.), they feel indifference.

Egocentrism implies a special emphasis on the importance that the person attributes to himself, in contrast to that assigned to the rest of the individuals around him. This way of thinking usually results in a preference for relationships in which a dynamic of evident hierarchical inequality can be established. The psychopath would be located at the top of this pyramid, promoting an asymmetry in the rights and duties that are attributed to all parties.

Self-centeredness can be accompanied by emotional immaturity, a tendency to devalue others, exaggeration of self-worth, and the use of blackmail or extortion. This is why it ends up unleashing conflicts within the family, which further degrade coexistence.

10. Possibility of adaptation

Many people with psychopathy rank high in the social hierarchy, including political or managerial positions (detecting a higher prevalence in these populations). In these contexts, asymmetric relationships with subordinates or with people under their charge can develop in a socially acceptable way. This ability to adapt occurs among psychopaths who are less impulsive and have superior planning skills.

Psychopaths adapt to the demands of the future with ease. This fact is due to an almost exclusive orientation towards the immediate, so that what will happen later is relegated to a second (or third) order of importance. As a consequence of this way of facing reality, it is about people with a low level of anxiety.

Is psychopathy a disease?

As noted above, current diagnostic manuals (DSM-5) do not include the figure of psychopathy among their proposals, so a diagnosis for it cannot be clearly established. Approaches to the phenomenon (such as antisocial disorder) are insufficient, since they focus their entire clinical description on purely behavioral aspects that do not capture the complexity of the phenomenon at hand (especially at the cognitive and experiential).

The truth is that most people sometimes react impulsively, or act indifferently in situations where they should not (according to social norms). It is also very common to seek stimulation to escape boredom or monotony. Thus, the features of psychopathy describe behaviors that occur (in general) in the entire population, although nuanced by the fact that in their case they extend in an absolute way to all daily experience (they are no exception punctual).

Many studies are currently focusing their efforts on the study of the amygdala, the prefrontal cortex and the limbic region as the structures that could explain the particular affective and behavioral pattern of psychopathy. Advances in neuroimaging technologies will allow for greater knowledge on this issue and determine a base cause, finally clarifying whether we are facing a pathology or a particular way of being and feel.

Bibliographic references:

• Anderson, N.E. and Kiehl, K.A. (2014). Psychopathy: Developmental Perspectives and their Implications for Treatment. Restorative Neurology and Neurosciencie, 32 (1), 103-117.
• Gao, Y. and Raine, A. (2010). Successful and Unsuccessful Psychopaths: A Neurobiological Model. Behavioral Sciences and the Law, 28, 194-210.