Psychopathy as a Disability?

By July 6, 2018 mental health

eery-1648250_1920.jpgPsychopathy is a hotly debated topic in the psychiatric community and in society at large. The nature of psychopathy is a frightening one and the root causes of the personality disorder are largely unknown. A person who is diagnosed as being a psychopath may exhibit symptoms such as reckless spending, violence towards animals and arson, ordinarily starting from a very young age. Psychopathy is generally understood by most people to be characterized by diminished capacity for empathy towards other people and living beings.

“It stuns me, as much as it did when I started 40 years ago, that it is possible to have people who are so emotionally disconnected that they can function as if other people are objects to be manipulated and destroyed without any concern.” – Professor Robert Hare, criminal psychologist

Despite the stigma the label psychopath carries, it remains the most common way to refer to a person who suffers from anti-social personality disorder. The traits that make up anti-social personality disorder form a cluster referred to as ‘psychopathic traits’. The overlap between the labels of psychopathy and anti-social personality disorder is so severe that the initially different classifications have essentially merged into one group over time in the public opinion.

The distinction between anti-social personality disorder and psychopathy is simple on a clinical level. Psychopathy as a disorder is essentially a more severe and rarer evolution of anti-social personality disorder. It’s estimated that only 1% of the population fit the criteria for a psychopathy diagnosis.

Adding to the confusion surrounding what defines a psychopath is the secondary distinction between ‘primary psychopaths’ who are considered to be psychopaths by nature or birth and ‘secondary psychopaths’ who are considered to have developed psychopathic traits due to environment or other outside influences.

One theory put forward about the possible origins of psychopathic traits is simply that a person with psychopathy suffers from diminished brain function. However, among the other defining traits of psychopathy, a person diagnosed as such will almost always display excellent manipulation skills and an uncanny ability to climb social ladders. This may indicate that children and adults who suffer from psychopathy do experience diminished brain function, but only so far as it limits their ability to comprehend emotions that most of society takes for granted. There is no indication that this personality disorder affects the functioning of any given person on other levels such as language comprehension, social skills or impedes their ability to learn.

Research has shown that psychopaths’ brains differ structurally from healthy brains.  University of Wisconsin-Madison researchers discovered the variance studying images of prisoners’ brains that could help explain the callous and impulsive anti-social behavior exhibited by some psychopaths.  The study showed that psychopaths have reduced connections between the ventromedial prefrontal cortex (vmPFC), responsible for sentiments such as empathy and guilt, and the amygdala, which reconciles fear and anxiety.  These areas are important in understanding other people’s emotions and intentions and are activated when people consider moral behavior. Damage to these areas is associated with impaired empathizing with other people, a poor response to fear and distress, and a lack of self-conscious emotions such as guilt or embarrassment.

In another study, psychopathic traits were linked to head injury.  Criminals who had been diagnosed with anti-social personality disorder—which is often seen as being synonymous to psychopathy—were given brain scans.  Their scans were then compared to healthy brain and scans from people who had suffered traumatic brain injuries. When examined, the brains of the criminals displayed impairment on the same areas of the brain that the injury survivors had shown. The frontal lobe was the main area shown to be affected by the diminished function, leading researchers to believe there may be a link between frontal lobe dysfunction and psychopathic traits.

Phillip Garrido, the man who kidnapped Jaycee Dugard and kept her hostage for years, suffered from a motorcycle accident when he was a younger man and experienced serious brain trauma as a result. According to his father, his personality changed radically after the accident, and not for the better. His case is one frequently quoted as being some of the strongest anecdotal evidence supporting the theory that psychopathy is rooted in physical brain defects or trauma.

While there is currently no known cure for psychopathy, this discovery has led many to wonder whether the treatment of psychopathic personality traits may be due for a change. The frontal cortex is responsible for the emotional processing and functioning of a person, and when a survivor of a traumatic brain injury receives an injury to the frontal cortex, they show a comparable difficulty in processing empathy when compared to someone with psychopathic traits.

“Seeing as psychopathic behavior is similar to that of a person with brain damage, it could be that it could benefit from similar forms of treatment.”

-Dr. Shamay-Tsoory, University of Haifa

Reputable treatments for traumatic brain injuries include talk therapy, cognitive behavioral therapy and anger management, all of which may be useful for the treatment of psychopathy. The idea of using positive reinforcement and rewards to teach appropriate behavior to young children who display traits of psychopathy has also been considered throughout recent history. Intervention with medication can also be successful, but with widely varied results depending on the type of medication used and the severity of symptoms.

If psychopathic traits are detected and are not treated effectively, the consequences can be devastating, both for the individual and society as well. Psychopaths are not only more likely to commit violent crimes and premeditated crimes, but they also have the highest rate of re-offense upon release from prison, which is seen in studies comparing psychopathic offenders to their non-psychopathic counterparts.

Despite the association between psychopathy and crime, the fact remains that as with all personality disorders, psychopathy exists on a spectrum. Someone who scores abnormally high on the test of psychopathy indicators may still be on the low end of symptom severity. It’s possible for someone with psychopathy to manifest their emotional insensitivity to their advantage, even using cutthroat abilities to deceive as a way to get ahead.

Treating someone with psychopathy can present a unique set of concerns. The idea of teaching someone to understand an emotion that to the best of our knowledge, they have never felt, is daunting. As well, because of the way psychopathic traits impede a sense of morality, it can be challenging to even begin to explain why a person with moderate to severe psychopathy should even participate in treatment when it likely doesn’t benefit the patient on a personal level.

The idea of psychopathy not being a ‘mental disorder’ but instead a disability of sorts, not unlike brain damage, could shift the framework when it comes to the way that we view the incredibly controversial disorder.