What is a psychopath?

Massachusets: “Society’s response to psychopaths is equal parts fascination and horror.” The reality of psychopathy is less B-horror movie and more about someone who meets very specific clinical diagnostic criteria, says Ron Schouten, JD, MD, director of the MGH Law & Psychiatry Service and co-author of Almost a Psychopath. So what exactly is a psychopath? “Psychopathy is a psychological condition that is essentially an extreme form of antisocial personality disorder, marked by characteristic behaviors and internal emotional experiences,” he says. “Some of the most common symptoms include a lack of empathy for others, manipulative behavior and disregard for the difference between right and wrong.”

Psychopathy can be diagnosed by using one of several diagnostic instruments, the most famous of which is the Psychopathy Checklist Revised (PCL-R). “The PCL-R has 20 items which can be scored as zero (not applicable), 1 (possibly present or present in some situations), or 2 (definitely present) based on the person’s behavior and responses,” says Schouten. “The maximum score is a 40, and anyone who scores between 30 and 40 is considered a true psychopath.”
Even people who have fewer symptoms – scoring between 20 and 30 – can exhibit extremely problematic behaviors that cause distress and harm to those around them, Schouten says. It is estimated that about 1 percent of the U.S. population meets the criteria for psychopathy, meaning there are more than 3 million psychopaths nationwide. About 15 percent of the population meets the criteria for subsyndromal psychopathy – or serious symptoms and problematic behavior – but fall short of a full diagnosis. One interesting fact, says Schouten, is while psychopaths make up about 15 to 30 percent of the prison population, they account for 50 percent of crimes.
Further complicating the understanding of psychopathy are a number of common myths, including that all psychopaths are serial killers, or routinely engage in acts of violence. Research shows many psychopaths are never violent; instead, their psychopathy takes the form of manipulating and taking advantage of others. Another myth, says Schouten, is that psychopaths are evil geniuses, with higher IQs than the general population. “The myth of superior intellect may be the result of the abilities of psychopaths to manipulate others, but in reality it is simply about street smarts rather than intellectual gifts.”