Let's talk psychopathy.

Psychopaths. The word we all know. The quickest label that exists. Let's see what it actually is.

Psychopathy is a concept that carries strong connotations of evilness and dangerousness. In media and popular science, the psychopath is commonly portrayed either as a brutal mass murderer or as a vicious boss. Descriptions of individuals with clear psychopathic traits can be found in ancient literature, and clinical descriptions of psychopathic inpatients trace back to the 18th century. Psychopathy is an important personality construct in the forensic field, and psychopathy assessments are extensively used to inform legal decisions in North America and throughout Europe.

This entry describes the leading definitions and assessments of psychopathic traits, in both criminal and noncriminal settings. Psychopathic traits in childhood and adolescence are discussed with reference to causal theories. Also included are sections on the use of psychopathy assessments for legal decision-making purposes and on past and recent approaches to treatment of psychopathic offenders.

Conceptualization and Assessment of Psychopathy

Historical Overview

In the early 19th century, French psychiatrist Philippe Pinel described inpatients who repeatedly engaged in violent and reckless behavior, despite appearing rational and mentally sound. According to Pinel, this peculiar psychiatric condition was characterized by insanity without delirium. Toward the end of the century, in the era of early psychiatric classifications, German psychiatrist Julius Ludwig August Koch proposed the term psychopathic personalities to characterize a relatively broad spectrum of conditions (e.g., mental retardation, neurotic conditions, so-called character disorders) that he believed had a biological basis. Although these early clinical accounts are less specific than contemporary definitions of psychopathy, they provide an illustration of how psychopathic individuals were seen to differ from other psychiatric inpatients.

American psychiatrist Hervey Cleckley’s book The Mask of Sanity, first published in 1941, marks the first milestone in the modern conceptualization of psychopathy. The book contains 15 detailed case descriptions drawn from hundreds of patients seen by Cleckley at the University of Georgia’s Medical Hospital. Based on salient features evident in these various cases, Cleckley formulated 16 clinical criteria for psychopathy, which encompassed not only features of emotional disturbance (e.g., shallow affect, lack of insight, deceitfulness) and behavioral deviance (e.g., failure to learn by experience, irresponsibility, promiscuity) but also some ostensibly adaptive features (e.g., superficial charm, absence of irrational thinking and nervousness, low propensity for suicidal behavior). In essence, Cleckley viewed psychopathy as a contradictory condition in which afflicted individuals appear rational and well functioning on the surface; however, over time, the mask of normality cleaves to reveal a deep-seated emotional disturbance and irresponsible, self-centered, and aimless behavioral deviancy (e.g., lying, stealing, forging checks). In contrast with accounts of criminal psychopathy from Cleckley’s time to the present, it is worth noting that few of the psychopathic patients that he described were overtly aggressive or violent.

Cleckley’s clinical criteria influenced the diagnostic descriptions of personality disorders in the first and second editions of the American Psychiatric Association’s reference book for psychopathological conditions: the Diagnostic and Statistical Manual of Mental Disorders (DSM-I and DSM-II).

In line with Cleckley’s conceptualization, the diagnostic criteria for conditions labeled sociopathic personality disturbance antisocial reaction and antisocial personality in these early editions of the DSM included distinct personality features (e.g., callousness, selfishness, absence of remorse or shame). In the third edition of the DSM (DSM-III), however, the corresponding diagnosis of antisocial personality disorder (ASPD) was largely based on observable deviant behaviors including destructive and delinquent acts (e.g., physical cruelty, vandalism), while excluding several of the personality-oriented criteria identified by Cleckley (e.g., superficial charm, lack of anxiety).

These revisions to the diagnostic criteria within the DSM-III were influenced by two factors in particular. One is that personality features were considered difficult to score in a reliable manner at that time. A second factor was the strong emphasis placed on behavioral indicators of antisociality in the highly influential work of psychiatric epidemiologist Lee Robins in the 1970s, focusing on developmental aspects of sociopathy in delinquent youths. The ASPD diagnosis as formulated in the DSM-III has remained essentially the same in subsequent editions of the manual (i.e., DSM-IV and DSM-5).

In the DSM-5, criterion-based definitions of ASPD and other personality disorders, equivalent to those in the DSM-IV, are included in Section II (“Diagnostic Criteria and Codes”). An alternative dimensional-trait system for personality disorders appears in Section III (“Emerging Measures and Models”). In this alternative system, ASPD is defined by high levels of disinhibitory and antagonistic traits and includes a psychopathy specifier for denoting the presence of distinct traits indicative of low-anxious, socially dominant (primary psychopathic) variant of ASPD. As such, the DSM-5 Section III definition captures key features of psychopathy that have been emphasized both in historic writings and in contemporary research work (as described next), but absent from ASPD as defined in the DSM-III and the DSM-IV.

Contemporary Conceptualizations of Psychopathy

In contrast to ASPD, psychopathy encompasses interpersonal-affective (i.e., charming-manipulative and callous-exploitative) traits along with impulsive-antisocial (i.e., disinhibitory-externalizing) tendencies. The most widely used rating scale for assessing psychopathy is the Psychopathy Checklist–Revised (PCL-R). The PCL-R was developed for use with correctional and forensic populations and has been used with both male and female offenders.

The PCL-R assesses psychopathy in terms of 20 items, each scored 0–2 on the basis of information derived from a face-to-face interview and institutional file records. The suggested cutoff for psychopathy is a PCL-R total score of 30 in the North American context, with slightly lower thresholds in some European countries. The predecessor to the PCL-R, the 22-item PCL, was formulated partly based on a global rating protocol that reflected Cleckley’s clinical conceptualization. However, in the process of selecting and refining items for the PCL, adaptive features in Cleckley’s conceptualization (e.g., absence of nervousness) were omitted. Consequently, the PCL-R items strongly emphasize deviant and criminal behavior. The PCL-R has several alternative versions, including the Psychopathy Checklist Screening Version, a briefer screening protocol suited for assessment contexts in which file information is lacking (e.g., psychiatric inpatients, community groups).

There is an asymmetric overlap between ASPD as defined in the DSM-5 Section II and psychopathy as assessed by the PCL-R: Most individuals who qualify for a PCL-R diagnosis of psychopathy also meet criteria for ASPD; however, the reverse is not true (i.e., only a portion of individuals with ASPD also meet criteria for psychopathy). Highlighting this, the estimated prevalence of ASPD in correctional populations is 50–80%, with the corresponding figure for psychopathy being 15–25%. The PCL-R encompasses two broad factors that show contrasting correlates with various external criteria (e.g., trait-dispositional, behavioral, physiological, clinical). The affective-interpersonal Factor 1 (F1) demonstrates positive associations not only with maladaptive tendencies of certain types (e.g., narcissism, thrill seeking, instrumental aggression) but also with some adaptive criterion measures (e.g., verbal ability, social assertiveness, emotional resiliency). The lifestyle-antisocial Factor 2 (F2), however, is predominantly associated with adverse outcomes (e.g., stimulation seeking, impulsivity, aggressiveness, alcohol and drug problems). The two PCL-R factors can be further subdivided into narrower facets (interpersonal, affective, impulsiveirresponsible, antisocial) that show distinctive correlates.

The Comprehensive Assessment of Psychopathic Personality–Institutional Rating Scale was developed as an alternative interview-based measure for use in correctional and clinical settings. The scale indexes psychopathy in terms of trait tendencies within six domains: Attachment, Behavioral, Cognitive, Dominance, Emotional, and Self. The Comprehensive Assessment of Psychopathic Personality symptoms can be assessed over differing time frames, ranging from past 6 months to lifetime.

Dimensional Psychopathic Traits and Self-Report Measures

In early clinical accounts and in previous editions of the DSM, psychopathy and ASPD have been conceptualized as discrete clinical syndromes. Psychopathy assessments are commonly used in current applied and legal contexts to generate statements regarding whether an individual meets criteria for psychopathy or not. During the 2000s, however, researchers have increasingly moved away from the position that psychopathy represents a discrete category. There is now strong consensus that psychopathic traits are dimensional (i.e., that individuals can have psychopathic traits to different degrees) and can be assessed in the population at large. Even though psychopathy was mainly investigated in criminal groups up until the 1990s, research on psychopathic traits in clinical and community groups has increased substantially. Investigating psychopathic traits in dimensional terms provides opportunities to gain improved understanding of how differing constellations of traits develop, manifest, and progress over time. Such research can provide insight in how different configurations of psychopathic traits are associated with behavioral (e.g., impulsivity, decision-making) and physiological variables (e.g., reactivity to fear cues and punishment).

Different self-report measures have been developed for assessing psychopathy as a dimensional construct outside of criminal settings, including the Levenson Self-Report Psychopathy Scale, the Hare Self-Report Psychopathy Scale, the Psychopathic Personality Inventory–Revised (PPI-R), the Triarchic Psychopathy Measure (TriPM), and the Elemental Psychopathy Assessment.

The different instruments for assessing psychopathic traits are based on theories of psychopathy that converge to a substantial extent; however, they also diverge to some degree. For example, in contrast to the Hare Self-Report Psychopathy Scale, the PPI-R does not include items directly referencing antisocial behavior, and it includes some semi-adaptive traits (e.g., fearlessness, stress immunity) emphasized in Cleckley’s description. A common or definite conceptualization of psychopathy is still lacking, and several points are still debated, including the following: (a) whether psychopathy encompasses semi-adaptive features, (b) whether antisocial and criminal behavior should be included in the mere definition of psychopathy or rather be considered potential consequences of psychopathic traits, (c) whether lack of anxiety is inherent to psychopathy, and (d) whether there are different subtypes of psychopathy.

Psychopathic Traits in Childhood and Adolescence

In line with theoretical models for psychopathy in adults, research has demonstrated that psychopathic traits in children and adolescents encompass three distinct components: affective, and interpersonal, features (e.g., callousness, remorselessness, grandiosity, manipulative behavior) along with impulsive-behavioral tendencies (e.g., irresponsibility, impulsiveness, thrill seeking). Elevated psychopathic traits in youths have been associated with various adverse outcomes (e.g., cruelty, substance misuse, aggressive and violent behavior). Different instruments exist for assessing psychopathic traits in youth, including the interview-based Psychopathy Checklist: Youth Version, which is a direct counterpart to the PCL-R, and the informant- (i.e., parent- or teacher-) rated Antisocial Process Screening Device and Child Psychopathy Scale. Self-report instruments also exist for assessing psychopathic traits in older children and adolescents, including questionnaire versions of the Antisocial Process Screening Device, Child Psychopathy Scale, the Youth Psychopathy Traits Inventory, and the Inventory of Callous-Unemotional Traits. There has been extensive interest since the mid-1990s in investigating callous-unemotional (CU) traits as a childhood precursor to core psychopathic traits in adulthood. Research has demonstrated that youths with conduct disorder (CD) who exhibit CU traits have distinct cognitive and affective impairments relative to those lacking in CU traits, and they present with elevated levels of aggression and more severe antisocial-delinquent behavior. For example, high levels of CU traits are associated with aberrant processing of fear- and punishment-related cues and also pain and distress in other people. This deviant affective processing is theorized to hinder the development of prosocial behavior and hence operates as a precursor to deficient lack of empathy and guilt. Research evidence indicates that CD with and without CU traits may have different etiological underpinnings and prognostic implications. CU traits appear to be moderately to strongly heritable, and it has been suggested that this symptom component is more stable over time than the impulsive-antisocial component and thus constitutes a key vulnerability factor for psychopathy in adulthood.

Associations between psychopathic traits in youth and adult psychopathy remain unclear, however. The stability of psychopathic traits in general, and CU traits specifically, over longer time periods remains unclear. Advanced research designs are needed to clarify developmental trajectories of early psychopathic tendencies and how genetic factors relate to and interact with differing environmental factors (e.g., family influences, peer influences, socioeconomic status, neighborhood factors). Improved understanding in these areas may have important implications for treatment and intervention. In this regard, it is notable that the diagnostic criteria for child CD were revised in the DSM-5 to include a limited prosocial emotions specifier for designating a psychopathic variant of CD entailing the presence of salient CU traits. This change sets the stage for increased research along lines needed to advance what is known about the expression and stability of CU traits.

Etiology of Psychopathy

Considerable research has been devoted over many years to investigating causal factors in psychopathy. Existing theories are of two types: (1) theories emphasizing core deficits in emotional sensitivity or responsiveness (e.g., low fear) and (2) theories positing impairments in cognitive-attentional processing (e.g., impaired set shifting). Differing neurobiological correlates of psychopathy have been reported as support for these alternative theories. One of the most consistent involves a lack of normal enhancement of the startle blink reflex to acoustic probes presented during viewing of aversive foreground stimuli (e.g., scary or disturbing pictorial images) as compared with neutral or pleasant stimuli. This result, akin to a failure to jump upon hearing an unexpected noise while walking alone in a dark alley, has been interpreted as reflecting a lack of normal defensive (fear) reactivity. Another consistent finding involves reduced amplitude of cortical brain response to intermittent target stimuli, or following incorrect responses, in cognitive performance tasks—indicative of reduced cortical-attentional processing or impaired action monitoring. Yet other research using functional neuroimaging has demonstrated deficits in basic subcortical (amygdala) reactivity to interpersonal distress cues (e.g., fearful human faces) in individuals high on psychopathy.

As noted earlier, psychopathy encompasses differing symptomatic facets, and these facets show contrasting associations with physiological response indicators. For example, affective-interpersonal symptoms are associated with lack of aversive startle potentiation, and impulsive-antisocial symptoms are associated with reduced cognitive brain response. Dating back to work by David T. Lykken in the 1950s, there is also evidence for distinct subgroups of individuals high on psychopathy who differ in emotional reactivity: primary psychopaths, who show antisocial tendencies in conjunction with deficient emotion (in particular, lack of fear), and secondary psychopaths, who show antisocial tendencies in conjunction with emotional dysregulation (i.e., intense hostility and negative affect). Consistent with this perspective, research during the 2000s with both correctional samples and community groups has yielded evidence for two distinct subtypes of individuals high in overall psychopathy, distinguished in particular by low versus high scores on measures of negative emotionality (e.g., anxiety, depression, somatization). It is hypothesized that different etiological pathways might underpin these subgroups.

Weaknesses in emotional response systems appear to contribute especially to core affective-interpersonal features of psychopathy and perhaps to the primary subtype of psychopathic individual. Deficits in cognitive processing systems appear to contribute more to impulsive-antisocial features of psychopathy and perhaps to the secondary psychopathic type. A formal theoretic conceptualization that has been proposed to account for differing symptomatic (phenotypic) expressions of psychopathy, and causal sources contributing to these differing expressions, is the triarchic model.

Triarchic Model of Psychopathy

The triarchic model conceives of psychopathy as encompassing three separable symptomatic com ponents—disinhibition, boldness, and mean ness—that can be viewed as thematic building blocks for differing conceptions of psychopathy. Disinhibition encompasses tendencies toward impulsiveness, weak behavioral restraint, hostility and mistrust, and difficulties in regulating emotion. Meanness entails deficient empathy, lack of affiliative capacity, contempt toward others, predatory exploitativeness, and empowerment through cruelty and destructiveness. Referents for disinhibition and meanness include the finding of distinct Impulsive/Conduct Problems and CU symptom components in the child psychopathy literature and corresponding evidence for distinct disinhibitory and callous-aggression factors underlying impulse control (externalizing) problems in adults. The third triarchic construct, boldness, encompasses dominance, social assurance, emotional resiliency, and venturesomeness. Referents for boldness include the mask elements of Cleckley’s conception, the low fear theory of psychopathy, the affective-interpersonal factor of the PPI-R, and developmental research on fearless temperament as a possible precursor to psychopathy.

From the perspective of the triarchic model, Cleckley’s conception of psychopathy emphasized boldness and disinhibition, whereas criminally oriented conceptions (and affiliated measures, including the PCL-R and Antisocial Process Screening Device) emphasize meanness and disinhibition more so. According to the model, individuals high in disinhibitory tendencies would warrant a diagnosis of psychopathy if also high in boldness or meanness (or both), but individuals high on only one of these dimensions would not. Individuals with differing relative elevations on these three symptomatic dimensions would account for contrasting variants (subtypes) of psychopathy as discussed earlier.

A self-report instrument designed specifically to index the constructs of this conceptual model is the 58-item TriPM. The TriPM includes Disinhibition and Meanness scales derived from the Externalizing Spectrum Inventory, a questionnaire measure of problems and traits associated with externalizing psychopathology. The TriPM also includes a Boldness scale that indexes fearless tendencies in social-interpersonal, affective-experiential, and activity-preference domains. Although the TriPM is relatively new, promising evidence for its convergent and discriminant validity has begun to appear. In addition, considerable work has been done to establish scale measures of the triarchic model constructs using items from other existing psychopathy inventories including the PPI-R and the YPI.

The triarchic model may prove useful for reconciling alternative causal theories of psychopathy that have been proposed based on differing neurobiological and behavioral findings. For example, lack of startle enhancement during aversive cueing has been tied specifically to the interpersonal-affective factor of the PCL-R and the counterpart Fearless Dominance factor of the PPI-R—suggesting a link to the boldness component of psychopathy; by contrast, reduced brain potential responses in cognitive tasks appear more related to impulsive-externalizing tendencies associated with the disinhibition component of psychopathy. On the other hand, the finding of reduced subcortical response to affective facial cues has been tied to the CU traits factor of child/ adolescent psychopathy, a referent for meanness in the triarchic model. However, further research is needed to determine whether this finding reflects fear deficits common to meanness and boldness or deficits in affiliative capacity or empathy specific to meanness.

Psychopathy and Applied Criminology

Legal Decision-Making

In North America and throughout Europe, psychopathy assessments are commonly used to inform legal proceedings (e.g., regarding sentencing, parole) and decisions regarding institutional placement and surveillance. In the vast majority of cases, these assessments are conducted using the PCL-R or the PCL-Screening Version/Youth Version. The use of PCL-based psychopathy assessments in legal procedures regarding adult offenders in the United States has increased steadily since the 1990s and has also become relatively common in juvenile risk evaluations. Based on the well-established association between psychopathy and deviant behaviors, PCL-based psychopathy assessments are used to infer whether an individual has an elevated risk of criminal relapse or institutional misconduct. In some cases, PCL-based assessments are also used to exclude individuals from therapeutic intervention, based on preconceptions that psychopathy is untreatable. In some jurisdictions in North America, psychopathy assessments are specifically used to evaluate risk of sexual recidivism in so-called sexually violent predator cases or to inform decisions about indeterminate incarceration of dangerous offenders. Given this widespread use, increased information is needed regarding applied implications of PCL-R assessments (e.g., what cutoff levels are used and how total and factor scores are interpreted).

In risk evaluations, PCL-based psychopathy assessments have either been used individually or incorporated into instruments specifically designed to assess risk (e.g., the Historical-Clinical-Risk Management 20, the Violence Risk Appraisal Guide, and the Sex Offenders Risk Appraisal Guide)—although the PCL-R has been omitted as a requirement in the newest editions of some of these instruments (e.g., version 3 of the Historical-Clinical-Risk Management 20). In contrast with broader risk assessment protocols, the PCL-R itself does not encompass features that are empirically related to violence risk (e.g., substance abuse, psychiatric comorbidity). Moreover, the PCL-R items are scored based on lifetime occurrence; thus, the instrument is not suited to assessing changes following from interventions. Meta- analytic work has demonstrated comparable predictive validity for the PCL-R for future violence in comparison to risk-assessment instruments but lower predictive ability for sexual recidivism. Furthermore, accumulated research evidence indicates that the predictive validity of the PCL-R is mainly due to its antisocial facet (reflecting past delinquent/criminal behaviors), with limited additional predictive value of its other facets.

Another issue that is important to consider is the interrater reliability of the PCL-R in clinical field settings (i.e., consistency of scores across raters when the same individual is assessed repeatedly). Field research conducted in different jurisdictions (i.e., United States, Canada, Sweden) has demonstrated acceptable interrater reliability for the largely objective criteria in the PCL-R’s antisocial facet (e.g., number of previous offenses); however, markedly lower reliabilities have been found for the remaining facets reflecting interpersonal, affective, and impulsive-irresponsible traits. These findings highlight the need for caution in the use of PCL-R assessments in legal decision-making contexts and point to a need for research into ways for increasing the interrater reliability of PCL-R ratings in field and clinical settings.

In addition to the aforementioned shortcomings, the PCL-R assessments are labor-intensive, and their use is limited to institutionalized populations. Alternative self-report measures are often brief, easy to administer, and do not require additional training. Self-report measures have been criticized, however, on the grounds that psychopathic individuals lack insight into the nature and extent of their psychopathology and are prone to deceive and manipulate others. In particular, the vulnerability of such measures to response distortion and especially to faking good (i.e., the exaggeration of positive features and/or the minimization of negative features) raises concerns about the potential for false negatives (i.e., failures to detect psychopathy when present). This concern has been reinforced by research findings indicating that individuals high on psychopathy can successfully lower their scores on self-report psychopathy measures and that social desirability/faking good is negatively correlated with scores on various psychopathy scales. Even the use of validity scales, designed to detect dissimulation in responding, does not provide for adequate detection of deception on report-based psychopathy scales. Although such response biases do not necessarily compromise the validity of self-report psychopathy measures in research settings, and psychopathic individuals may not be as skilled in deceiving as often assumed, caution is still warranted in using self-report measures of psychopathy in settings (e.g., legal contexts) where respondents might have clear incentives to fake good.

Forensic Treatment

A long-standing view among both clinicians and researchers has been that psychopathic individuals are unchangeable and hence untreatable. This pessimistic view dates back at least to Cleckley, who argued that no treatment program could achieve fundamental changes in a psychopathic individual. Some empirical studies conducted in the 1990s on treatment of psychopathic offenders drastically fueled this pessimistic view. One of these studies examined the impact of an intensive therapeutic program on incidents of criminal and violent recidivism assessed over an average follow-up period of 10 years. The results indicated that psychopathic offenders—in contrast with nonpsychopathic offenders who showed reductions in violent and overall recidivism following treatment compared to matched untreated controls—showed relative increases in reoffense rates. The authors interpreted these results as indicating that the treatment program led psychopaths to become more skilled in their ability to manipulate and exploit others.

A subsequent study corroborated this finding— demonstrating that forensic patients with elevated PCL-R scores who exhibited positive responsiveness to treatment (e.g., motivation to participate, in-session compliance, positive change ratings) were more likely to reoffend following release than patients with lower PCL-R scores who received treatment or untreated patients. Other studies have indicated that PCL-R scores are related to disruptive behavior in treatment, higher dropout rates, and negative therapist perceptions of motivation and progress in treatment.

Understandably, the main findings from these empirical studies perpetuated the belief among clinicians and researchers that psychopathy is essentially untreatable. However, important criticisms have been leveled against these investigations. The study examining outcomes of the intensive therapeutic program, for example, has been criticized for the radical, punitive, intrusive, and unethical nature of the treatment program that was used. A subsequent reanalysis that evaluated reoffending during a longer follow-up period using an improved method for quantifying recidivism rates concluded that there was in fact no evidence that offenders high on psychopathy who exhibited positive treatment behavior reoffended at greater rates than other offenders.

Although research conducted during the 2000s suggests that psychopathic individuals typically do not respond positively to standard treatment interventions administered in mental health or justice settings, there are indications that intensive treatment interventions tailored to the emotional, cognitive, and motivational styles of individuals with psychopathic traits can be effective. Three types of treatment programs can be distinguished, each focusing on a different outcome: (1) reducing criminal behavior, (2) targeting underlying mechanisms of psychopathy, and (3) reducing level of psychopathic traits.

Treatment programs that focus on reduction of risk of future violence and other criminal behaviors have shown evidence of effectiveness with adult and juvenile offenders high on psychopathy. For example, published studies suggest that psychopathic offenders who complete an intensive specialized treatment program are less likely to be reconvicted for sexual or other violent offenses and that in cases where recidivism occurs, it tends to involve less serious offenses compared to pretreatment.

Treatment programs focusing on the core deficits of psychopathy have the potential benefit of being tailored to the unique needs of both youth and adults with psychopathic traits. For example, a study focusing on children and adolescents randomly assigned either to a typical parental training intervention or an emotional-recognition training group demonstrated that children with elevated CU traits who received training in accurate perception and interpretation of emotions of others showed greater improvements in affective responding compared to those in the typical parent training group. Other recent work has examined whether affective-attentional impairments in adult offenders high on psychopathy could be altered through cognitive remediation training. Specifically, offenders scoring high in psychopathy were offered a training to remedy their lack of attention to contextual information. Following this training, the participants improved both on attention to contextual-specific trained tasks and on untrained tasks. Although findings from these studies are promising, it remains to be determined whether remediation of processing impairments such as these will lead to actual harm reduction (e.g., decrease of violent behavior).

A third treatment approach is to focus on reducing the level of psychopathic tendencies exhibited. However, research on the changeability of psychopathy traits remains scarce. Although prominent writers have argued that the personality structure of psychopathic individuals is largely unalterable, there are some indirect and direct indications that this position may be inaccurate. First, empirical work has challenged the idea that personality disorders in general are enduring and stable. For example, treatment has been shown to attenuate symptoms of severe disorders such as borderline personality. Second, some work has shown that interventions have the potential to alter core dispositions associated with psychopathy in youth (i.e., callous-unemotional, narcissistic, and impulsive traits).

Replication studies in larger samples, with the use of randomized controlled trials, will be needed to corroborate these more positive findings pertaining to treatment of psychopathic individuals.

References:

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