psychopathy psychopathy psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent antisocial behavior, impaired empathy and remorse, and bold, disinhibited, and egotistical traits. different conceptions of psychopathy have been used throughout history that are only partly overlapping and may sometimes be contradictory. not to be confused with psychosis, psychopathology, psychic, or sycophancy. psychopathypronunciation/saɪˈkɒpəθi/ specialtypsychiatry, clinical psychologysymptomsboldness, superficial charm, pathological lying, lack of empathy or remorse, inclination to violence and manipulation, impulsivity, narcissismcausesgenetic and environmentalrisk factorsfamily history, poverty, parental neglectdifferential diagnosisantisocial personality disorder, narcissism, sadism, borderline personality disorderprognosispoorfrequency1% of general population personality disorders cluster a (odd) paranoid schizoid schizotypal cluster b (dramatic) antisocial borderline histrionic narcissistic cluster c (anxious) avoidant dependent obsessive–compulsive not otherwise specified depressive depressive cyclothymic others passive–aggressive masochistic sadistic psychopathy haltlose immature post-traumatic organic 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. 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. canadian psychologist robert d. hare later repopularized the construct of psychopathy in criminology with his psychopathy checklist. 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. 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. while the term is often employed in common usage along with "crazy", "insane", and "mentally ill", there is a categorical difference between psychosis and psychopathy. history etymology the word psychopathy is a joining of the greek words psyche (ψυχή) "soul" and pathos (πάθος) "suffering, feeling". the first documented use is from 1847 in germany as psychopatisch, and the noun psychopath has been traced to 1885. 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, 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. 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. 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. 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, but it is also used as shorthand for psychotic or crazed. 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. sociopathy the word element socio- has been commonly used in compound words since around 1880. 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. 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. 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 that see the causes as due to social factors and early environment, and the term psychopathy preferred by those who believe that there are psychological, biological, and genetic factors involved in addition to environmental factors. 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. precursors ancient writings that have been connected to psychopathic traits include deuteronomy 21:18–21, which was written around 700 bce, and a description of an unscrupulous man by the greek philosopher theophrastus around 300 bce. 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. 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. 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. 20th century psychoanalyst walter c. langer described adolf hitler as a "neurotic psychopath". 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. the scottish psychiatrist david henderson had also been influential in europe from 1939 in narrowing the diagnosis. the diagnostic category of sociopathic personality in early editions of the diagnostic and statistical manual (dsm) had some key similarities to cleckley's ideas, though in 1980 when renamed antisocial personality disorder some of the underlying personality assumptions were removed. 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), and is the most widely used measure of psychopathy. there are also several self-report tests, with the psychopathic personality inventory (ppi) used more often among these in contemporary adult research. 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, non-medical psychoanalyst walter c. langer suggested adolf hitler was probably a psychopath. 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. definition concepts psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. completely lacking in conscience and in feelings for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret. —robert d. hare, 1993, p. xi there are multiple conceptualizations of psychopathy, 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. 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. 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'. the triarchic model 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. 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. 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. 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. measurement 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. 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. 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. 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". 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. personality dimensions studies have linked psychopathy to alternative dimensions such as antagonism (high), conscientiousness (low) and anxiousness (low). 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