Psychopathy, or psychopathic personality,^[1] is a personality construct^[2][3] characterized by impaired empathy and remorse, and bold, disinhibited and egocentric traits, masked by superficial charm and the outward appearance of apparent normalcy.^[4][5][6][7]

Hervey M. Cleckley, an American psychiatrist, influenced the initial diagnostic criteria for antisocial personality reaction/disturbance in the Diagnostic and Statistical Manual of Mental Disorders (DSM), as did American psychologist George E. Partridge.^[8] The DSM and International Classification of Diseases (ICD) subsequently introduced the diagnoses of antisocial personality disorder (ASPD) and dissocial personality disorder (DPD) respectively, stating that these diagnoses have been referred to (or include what is referred to) as psychopathy or sociopathy. The creation of ASPD and DPD was driven by the fact that many of the classic traits of psychopathy were impossible to measure objectively.^{[9][10][11][12][13]} Canadian psychologist Robert D. Hare later re-popularized the construct of psychopathy in criminology with his Psychopathy Checklist.^{[9][11][14][15]}

Although no psychiatric or psychological organization has sanctioned a diagnosis titled "psychopathy", assessments of psychopathic characteristics are widely used in criminal justice settings in some nations and may have important consequences for individuals.^[specify] The study of psychopathy is an active field of research. The term is also used by the general public, popular press, and in fictional portrayals.^[15][16] While the abbreviated term "psycho" is often employed in common usage in general media along with "crazy", "insane", and "mentally ill", there is a categorical difference between psychosis and psychopathy.^[17]

The word psychopathy is a joining of the Greek words psyche (ψυχή) "soul" and pathos (πάθος) "suffering, feeling".^[18] The first documented use is from 1847 in Germany as psychopatisch,^[19] and the noun psychopath has been traced to 1885.^[20] In medicine, patho- has a more specific meaning of disease (Thus pathology has meant the study of disease since 1610, and psychopathology has meant the study of mental disorder in general since 1847. A sense of "a subject of pathology, morbid, excessive" is attested from 1845,^[21] including the phrase pathological liar from 1891 in the medical literature).

The term psychopathy initially had a very general meaning referring to all sorts of mental disorders and social aberrations, popularised from 1891 in Germany by Koch's concept of "psychopathic inferiority" (psychopathische Minderwertigkeiten). Some medical dictionaries still define psychopathy in both a narrow and broad sense, such as MedlinePlus from the U.S. National Library of Medicine.^[22] On the other hand, Stedman's Medical Dictionary defines "psychopath" only as a "former designation" for a person with an antisocial type of personality disorder.^[23]

The term psychosis was also used in Germany from 1841, originally in a very general sense. The suffix -ωσις (-osis) meant in this case "abnormal condition". This term or its adjective psychotic would come to refer to the more severe mental disturbances and then specifically to mental states or disorders characterized by hallucinations, delusions or in some other sense markedly out of touch with reality.^[24]

The slang term psycho has been traced to a shortening of the adjective psychopathic from 1936, and from 1942 as a shortening of the noun psychopath,^[25] but it is also used as shorthand for psychotic or crazed.^[26]

The media usually uses the term psychopath to designate any criminal whose offenses are particularly abhorrent and unnatural, but that is not its original or general psychiatric meaning.^[27]

The word element socio- has been commonly used in compound words since around 1880.^[28][29] The term sociopathy may have been first introduced in 1909 in Germany by biological psychiatrist Karl Birnbaum and in 1930 in the US by educational psychologist George E. Partridge, as an alternative to the concept of psychopathy.^[28] It was used to indicate that the defining feature is violation of social norms, or antisocial behavior, and may be social or biological in origin.^{[30][31][32][33]}

The terms sociopathy and psychopathy were once used interchangeably in relation to antisocial personality disorder; sociopathy is now outdated and is not a scientific term.^[34] Psychopathy, however, is a well documented and well defined construct in the scientific literature.^[35] There are many psychopathic personality traits; there are no 'sociopathic traits'. Furthermore, the DSM-5 introduced the dimensional model of personality disorders in Section III, which includes a specifier for diagnosing psychopathy.^[36] According to the DSM, primary psychopathy is diagnosed when an individual meets criteria for both Antisocial Personality Disorder + it's Psychopathic Features Specifier.^[37] The Psychopathic Features Specifier has been modeled on Factor 1 of the Psychopathic Personality Inventory, known as Fearless Dominance. This explicates Psychopathy as not being a more extreme version of ASPD, but as an emergent compound trait that manifests when Antisocial Personality Disorder is present in combination with high levels of Fearless Dominance (or Boldness as it's known in the Triarchic Model).^[38] Analyses showed that this Section III ASPD greatly outperformed Section II ASPD in predicting scores on Hare’s (2003) Psychopathy Checklist-Revised.^[39]

Section III ASPD including the 'Psychopathic Traits Specifier' can be seen on page 765 of the DSM-5 or Page 885 of the DSM-5-TR.^[40]

The term is used in various ways in contemporary usage. Robert Hare stated in the popular science book Snakes in Suits that sociopathy and psychopathy are often used interchangeably, but in some cases the term sociopathy is preferred because it is less likely than is psychopathy to be confused with psychosis, whereas in other cases the two terms may be used with different meanings that reflect the user's views on its origins and determinants. Hare contended that the term sociopathy is preferred by those who see the causes as due to social factors and early environment, and the term psychopathy is preferred by those who believe that there are psychological, biological, and genetic factors involved in addition to environmental factors.^[5] Hare also provides his own definitions: he describes psychopathy as lacking a sense of empathy or morality, but sociopathy as only differing from the average person in the sense of right and wrong.^[41][42]

Ancient writings that have been connected to psychopathic traits include Deuteronomy 21:18–21 and a description of an unscrupulous man by the Greek philosopher Theophrastus around 300 BC.^[43]

The concept of psychopathy has been indirectly connected to the early 19th century work of Pinel (1801; "mania without delirium") and Pritchard (1835; "moral insanity"), although historians have largely discredited the idea of a direct equivalence.^[44] Psychopathy originally described any illness of the mind, but found its application to a narrow subset of mental conditions when it was used toward the end of the 19th century by the German psychiatrist Julius Koch (1891) to describe various behavioral and moral dysfunction in the absence of an obvious mental illness or intellectual disability. He applied the term psychopathic inferiority (psychopathischen Minderwertigkeiten) to various chronic conditions and character disorders, and his work would influence the later conception of the personality disorder.^[9][45]

The term psychopathic came to be used to describe a diverse range of dysfunctional or antisocial behavior and mental and sexual deviances, including at the time homosexuality. It was often used to imply an underlying "constitutional" or genetic origin. Disparate early descriptions likely set the stage for modern controversies about the definition of psychopathy.^[9]

An influential figure in shaping modern American conceptualizations of psychopathy was American psychiatrist Hervey Cleckley. In his classic monograph, The Mask of Sanity (1941), Cleckley drew on a small series of vivid case studies of psychiatric patients at a Veterans Administration hospital in Georgia to provide a description for psychopathy. Cleckley used the metaphor of the "mask" to refer to the tendency of psychopaths to appear confident, personable, and well-adjusted compared to most psychiatric patients, while revealing underlying pathology through their actions over time. Cleckley formulated sixteen criteria for psychopathy.^[9] The Scottish psychiatrist David Henderson had also been influential in Europe from 1939 in narrowing the diagnosis.^[46]

The diagnostic category of sociopathic personality in early editions of the Diagnostic and Statistical Manual (DSM)^[47] had some key similarities to Cleckley's ideas, though in 1980 when renamed Antisocial Personality Disorder some of the underlying personality assumptions were removed.^[11] In 1980, Canadian psychologist Robert D. Hare introduced an alternative measure, the "Psychopathy Checklist" (PCL) based largely on Cleckley's criteria, which was revised in 1991 (PCL-R),^[48][49] and is the most widely used measure of psychopathy.^[50] There are also several self-report tests, with the Psychopathic Personality Inventory (PPI) used more often among these in contemporary adult research.^[9]

Famous individuals have sometimes been diagnosed, albeit at a distance, as psychopaths. As one example out of many possible from history, in a 1972 version of a secret report originally prepared for the Office of Strategic Services in 1943, and which may have been intended to be used as propaganda,^[51][52] non-medical psychoanalyst Walter C. Langer suggested Adolf Hitler was probably a psychopath.^[53] However, others have not drawn this conclusion; clinical forensic psychologist Glenn Walters argues that Hitler's actions do not warrant a diagnosis of psychopathy as, although he showed several characteristics of criminality, he was not always egocentric, callously disregarding of feelings or lacking impulse control, and there is no proof he could not learn from mistakes.^[54]

There are multiple conceptualizations of psychopathy,^[9] including Cleckleyan psychopathy (Hervey Cleckley's conception entailing bold, disinhibited behavior, and "feckless disregard") and criminal psychopathy (a meaner, more aggressive and disinhibited conception explicitly entailing persistent and sometimes serious criminal behavior). The latter conceptualization is typically used as the modern clinical concept and assessed by the Psychopathy Checklist.^[9] The label "psychopath" may have implications and stigma related to decisions about punishment severity for criminal acts, medical treatment, civil commitments, etc. Efforts have therefore been made to clarify the meaning of the term.^[9]

It has been suggested that those who share the same emotional deficiencies and psychopathic features, but are properly socialized, should not be designated as 'psychopaths'.^[56]

The triarchic model^[4] suggests that different conceptions of psychopathy emphasize three observable characteristics to various degrees. Analyses have been made with respect to the applicability of measurement tools such as the Psychopathy Checklist (PCL, PCL-R) and Psychopathic Personality Inventory (PPI) to this model.^[4][9]

• Boldness. Low fear including stress-tolerance, toleration of unfamiliarity and danger, and high self-confidence and social assertiveness. The PCL-R measures this relatively poorly and mainly through Facet 1 of Factor 1. Similar to PPI fearless dominance. May correspond to differences in the amygdala and other neurological systems associated with fear.^[4][9]
• Disinhibition. Poor impulse control including problems with planning and foresight, lacking affect and urge control, demand for immediate gratification, and poor behavioral restraints. Similar to PCL-R Factor 2 and PPI impulsive antisociality. May correspond to impairments in frontal lobe systems that are involved in such control.^[4][9]
• Meanness. Lacking empathy and close attachments with others, disdain of close attachments, use of cruelty to gain empowerment, exploitative tendencies, defiance of authority, and destructive excitement seeking. The PCL-R in general is related to this but in particular some elements in Factor 1. Similar to PPI, but also includes elements of subscales in impulsive antisociality.^[4][9]

Psychopathy has been conceptualized as a hybrid condition marked by a paradoxical combination of superficial charm, poise, emotional resilience, and venturesomeness on the outside but deep-seated affective disturbances and impulse control deficits on the inside. From this perspective, psychopathy is at least in part characterized by psychologically adaptive traits.^[57] Furthermore, according to this view, psychopathy may be linked to at least some interpersonally successful outcomes, such as effective leadership, business accomplishments, and heroism.^{[9][58][59][60]}

An early and influential analysis from Harris and colleagues indicated that a discrete category, or taxon, may underlie PCL-R psychopathy, allowing it to be measured and analyzed. However, this was only found for the behavioral Factor 2 items they identified, child problem behaviors; adult criminal behavior did not support the existence of a taxon.^[61] Marcus, John, and Edens more recently performed a series of statistical analyses on PPI scores and concluded that psychopathy may best be conceptualized as having a "dimensional latent structure" like depression.^[62]

Marcus et al. repeated the study on a larger sample of prisoners, using the PCL-R and seeking to rule out other experimental or statistical issues that may have produced the previously different findings.^[63] They again found that the psychopathy measurements do not appear to be identifying a discrete type (a taxon). They suggest that while for legal or other practical purposes an arbitrary cut-off point on trait scores might be used, there is actually no clear scientific evidence for an objective point of difference by which to label some people "psychopaths"; in other words, a "psychopath" may be more accurately described as someone who is "relatively psychopathic".^[9]

The PCL-R was developed for research, not clinical forensic diagnosis, and even for research purposes to improve understanding of the underlying issues, it is necessary to examine dimensions of personality in general rather than only a constellation of traits.^[9][64]

Studies have linked psychopathy to alternative dimensions such as antagonism (high), conscientiousness (low) and anxiousness (low).^[65]

Psychopathy has also been linked to high psychoticism—a theorized dimension referring to tough, aggressive or hostile tendencies. Aspects of this that appear associated with psychopathy are lack of socialization and responsibility, impulsivity, sensation-seeking (in some cases), and aggression.^[66][67][68]

Otto Kernberg, from a particular psychoanalytic perspective, believed psychopathy should be considered as part of a spectrum of pathological narcissism, that would range from narcissistic personality on the low end, malignant narcissism in the middle, and psychopathy at the high end.^[68]

Psychopathy, narcissism and Machiavellianism, three personality traits that are together referred to as the dark triad, share certain characteristics, such as a callous-manipulative interpersonal style.^[69] The dark tetrad refers to these traits with the addition of sadism.^{[70][71][72][73][74][75]} Several psychologists have asserted that subclinical psychopathy and Machiavellianism are more or less interchangeable.^[76] There is a subscale on the Psychopathic Personality Inventory (PPI) dubbed "Machiavellian Egocentricity".^[77][78] Delroy Paulhus has asserted that the difference that most miss is that while both are characterized by manipulativeness and unemotionality, psychopaths tend to be more reckless.^[79] One study asserted that "the ability to adapt, reappraise and reassess a situation may be key factors differentiating Machiavellianism from psychopathy, for example".^[80] Psychopathy and machiavellianism were also correlated similarly in responses to affective stimuli, and both are negatively correlated with recognition of facial emotions.^[81][82] Many have suggested merging the dark triad traits (especially Machiavellianism and psychopathy) into one construct, given empirical studies which show immense overlap.^[83]

The current conceptions of psychopathy have been criticized for being poorly conceptualized, highly subjective, and encompassing a wide variety of underlying disorders. Dorothy Otnow Lewis has written:

The concept and subsequent reification of the diagnosis "psychopathy" has, to this author's mind, hampered the understanding of criminality and violence. According to Hare, in many cases one need not even meet the patient. Just rummage through his records to determine what items seemed to fit. Nonsense. To this writer's mind, psychopathy and its synonyms (e.g., sociopathy and antisocial personality) are lazy diagnoses. Over the years the authors' team has seen scores of offenders who, prior to evaluation by the authors, were dismissed as psychopaths or the like. Detailed, comprehensive psychiatric, neurological, and neuropsychological evaluations have uncovered a multitude of signs, symptoms, and behaviors indicative of such disorders as bipolar mood disorder, schizophrenia spectrum disorders, complex partial seizures, dissociative identity disorder, parasomnia, and, of course, brain damage/dysfunction.^[84]

Half of the Hare Psychopathy Checklist consists of symptoms of mania, hypomania, and frontal-lobe dysfunction, which frequently results in underlying disorders being dismissed.^[85] Hare's conception of psychopathy has also been criticized for being reductionist, dismissive, tautological, and ignorant of context as well as the dynamic nature of human behavior.^[86] Some have called for rejection of the concept altogether, due to its vague, subjective and judgmental nature that makes it prone to misuse.^[87] A systematic review determined that the PCL is weakly predictive of criminal behavior, but not of lack of conscience, or treatment and rehabilitation outcomes. These findings contradict widespread beliefs amongst professionals in forensics.^[88]

Psychopathic individuals do not show regret or remorse. This was thought to be due to an inability to generate this emotion in response to negative outcomes. However, in 2016, people with antisocial personality disorder and dissocial personality disorder were found to experience regret, but did not use the regret to guide their choice in behavior. There was no lack of regret but a problem to think through a range of potential actions and estimating the outcome values.^[89]

In an experiment published in March 2007 at the University of Southern California neuroscientist Antonio R. Damasio and his colleagues showed that subjects with damage to the ventromedial prefrontal cortex lack the ability to empathically feel their way to moral answers, and that when confronted with moral dilemmas, these brain-damaged patients coldly came up with "end-justifies-the-means" answers, leading Damasio to conclude that the point was not that they reached immoral conclusions, but that when they were confronted by a difficult issue – in this case as whether to shoot down a passenger plane hijacked by terrorists before it hits a major city – these patients appear to reach decisions without the anguish that afflicts those with typically functioning brains. According to Adrian Raine, a clinical neuroscientist also at the University of Southern California, one of this study's implications is that society may have to rethink how it judges immoral people: "Psychopaths often feel no empathy or remorse. Without that awareness, people relying exclusively on reasoning seem to find it harder to sort their way through moral thickets. Does that mean they should be held to different standards of accountability?"^[90]

Socially, psychopathy typically involves extensive callous and manipulative self-serving behaviors with no regard for others, and often is associated with repeated delinquency, crime and violence. Mentally, impairments in processes related to affect and cognition, particularly socially related mental processes, have also been found. Developmentally, symptoms of psychopathy have been identified in young children with conduct disorder, and suggests at least a partial constitutional factor that influences its development.^[91]

Disagreement exists over which features should be considered as part of psychopathy, with researchers identifying around 40 traits supposedly indicative of the construct,^[92][93] though the following characteristics are almost universally considered central.

Cooke and Michie (2001)^[94] proposed a three-factor model of the Psychopathy Checklist-Revised which has seen widespread application in other measures (e.g. Youth Psychopathic Traits Inventory,^[95] Antisocial Process Screening Device^[96]).

• Arrogant and deceitful interpersonal style: impression management or superficial charm, inflated and grandiose sense of self-worth, pathological lying/deceit, and manipulation for personal gain.
• Deficient affective experience: lack of remorse or guilt, shallow affect (coldness and unemotionality), callousness and lack of empathy, and failure to accept responsibility for own actions.
• Impulsive and irresponsible lifestyle: impulsivity, sensation-seeking and risk-taking, irresponsible and unreliable behavior, financially parasitic lifestyle and lack of realistic, long-term goals.

Cleckley's (1941) original description of psychopathy included the absence of nervousness and neurotic disorders, and later theorists referred to psychopaths as fearless or thick-skinned.^[97] While it is often claimed that the PCL-R does not include low anxiety or fearlessness, such features do contribute to the scoring of the Facet 1 (interpersonal) items, mainly through self-assurance, unrealistic optimism, brazenness and imperturbability.^[98] Indeed, while self-report studies have been inconsistent using the two-factor model of the PCL-R, studies which separate Factor 1 into interpersonal and affective facets, more regularly show modest associations between Facet 1 and low anxiety, boldness and fearless dominance (especially items assessing glibness/charm and grandiosity).^{[99][100][18]} When both psychopathy and low anxiety/boldness are measured using interviews, both interpersonal and affective facets are both associated with fearlessness and lack of internalizing disorders.^[20][21][22]

The importance of low anxiety/fearlessness to psychopathy has historically been underscored through behavioral and physiological studies showing diminished responses to threatening stimuli (interpersonal and affective facets both contributing).^[23] However, it is not known whether this is reflected in reduced experience of state fear or where it reflects impaired detection and response to threat-related stimuli.^[31] Moreover, such deficits in threat responding are known to be reduced or even abolished when attention is focused on the threatening stimuli.

In terms of simple correlations, the PCL-R manual states an average score of 22.1 has been found in North American prisoner samples, and that 20.5% scored 30 or higher. An analysis of prisoner samples from outside North America found a somewhat lower average value of 17.5. Studies have found that psychopathy scores correlated with repeated imprisonment, detention in higher security, disciplinary infractions, and substance misuse.^[101][102]

Psychopathy, as measured with the PCL-R in institutional settings, shows in meta-analyses small to moderate effect sizes with institutional misbehavior, postrelease crime, or postrelease violent crime with similar effects for the three outcomes. Individual studies give similar results for adult offenders, forensic psychiatric samples, community samples, and youth. The PCL-R is poorer at predicting sexual re-offending. This small to moderate effect appears to be due largely to the scale items that assess impulsive behaviors and past criminal history, which are well-established but very general risk factors. The aspects of core personality often held to be distinctively psychopathic generally show little or no predictive link to crime by themselves. For example, Factor 1 of the PCL-R and Fearless dominance of the PPI-R have smaller or no relationship to crime, including violent crime. In contrast, Factor 2 and Impulsive antisociality of the PPI-R are associated more strongly with criminality. Factor 2 has a relationship of similar strength to that of the PCL-R as a whole. The antisocial facet of the PCL-R is still predictive of future violence after controlling for past criminal behavior which, together with results regarding the PPI-R which by design does not include past criminal behavior, suggests that impulsive behaviors is an independent risk factor. Thus, the concept of psychopathy may perform poorly when attempted to be used as a general theory of crime.^[9][103] Zdroj:https://en.wikipedia.org?pojem=Psychopath
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