My pain in constant and sharp, and I do not hope for a better world for anyone. In fact, I want my pain to be inflicted on others. — Patrick Bateman (excerpt from the movie American Psycho)
Psychopathy is a general term used to describe psychopathic personality traits (e.g., sociopath), and broadly-construed definitions of psychopathy have been used interchangeably to characterize varieties of maladaptive behavior involving a requisite lack of empathy or remorse. The term Antisocial Personality Disorder is more clinically recognized and describes a pervasive pattern of disregard for others—combined with aggressive impulsivity and a history of criminality—as witnessed in multiple contexts. The word psychosis, however, refers to a loss of contact with reality featuring concomitant hallucinations, paranoia, or persistent delusions (i.e, “being psychotic”). Psychopathy and psychosis are not mutually exclusive in principle, but they particularize different states of mind. When one thinks of a rank-and-file psychopath, a culturally-influenced image may come to mind of B-movie serial killers, the rapacious CEO, or an unsavory date who transforms stalking into an endurance sport. However, most psychopaths are very ordinary looking individuals who often go under the radar until their actions are closely evaluated.
When looking at what generally constitutes abnormal psychology, genetic predispositions, and the vagaries of childhood development appear alarmingly interlaced with an incorrigible inability to conform to reasonable social norms in adulthood. A well-known model used to profile children who exhibit potential for developing a psychopathic disposition is referred to as the Macdonald triad (not the meal option). Formulated by psychiatrist J. M. Macdonald in 1963, this predictive rubric lists childhood behaviors that involve cruelty to animals, pyromania, and persistent bedwetting. Although many of these childhood features have retrospectively coincided with adult psychopathic behavior, consistent predictions based on this triad cannot be clinically established because these variables are too restrictive to account for protean forms of mental illness or myriad neurophysiological aspects affecting psychopathy. Nonetheless, a component of misplaced aggression appears statistically predominant when examining the childhoods of offender (especially with children who show callous-unemotional traits), and being the subject of childhood abuse appears to significantly increase risk factors for future violence or a lack of compunction.*
Based on brief encounters with antisocial personalities, I’ve noticed that externalized responses to self-loathing are sometimes combined with compensatory adaptation for repression. If one thinks of clinical narcissism as a complex defense mechanism to protect against feelings of vulnerability, deep insecurities and self-loathing could be root elements fueling the engine of dysfunctional social interactions. As a result, to compensate for low self-esteem or to release repressed impulses, externalized responses may take the form of asserting territorial dominance via dissociative reaction formation. In terms of serial predators, an imbrication of sexual obsession and narcissism is often predominant with the desire to control previously “uncontrollable” environments. Furthermore, the symbolic gesture cannot be underestimated as reenactments of former traumas may be psychologically resolved by assuming retributive ascendancy over feelings of powerlessness. For example, the abused can become the abuser as they develop the capacity to revisit former traumas in ways that feel irrevocably satisfying given their current leverage or sense of empowerment. Likewise, the psychosexual components of paraphilia and their theatrical manifestations implicate object relations and attachment theory when sexual sadism is a primary factor. The inability to reconcile destructive and tension-provoking thought patterns may also explain why life is of insufficient value to the psychopath—sometimes even their own. The demands of living simply become another nuisance to be strategically confronted, and social interactions represent opportunities for objectification, dramatization, manipulation, and defusing stress through transference. Nonetheless, psychopaths can be charismatic and captivating since they are adept at compartmentalization (hybristophilia enthusiasts unwittingly encourage this magnetism).
The field of comparative psychology is similar to ethology in that both disciplines study animal behavior, with the latter being more biologically focused. Humans, lest we forget, are animals. After all, it was the ethologist Konrad Lorenz who influenced John Bowlby in relation to his work in attachment theory. Regarding childhood development, our first and most significant mammalian attachment is introduced in our family of origin—usually with our parents. If an insecure attachment (i.e., anxious or disorganized) becomes paramount during childhood, a subsequent inability to form meaningful relationships as an adult may result in hostility, low levels of distress tolerance, impulsivity, distrust, deviance, and emotional dysregulation. As most antisocial personalities emerge from previous conduct-related disorders in childhood and adolescence, any genetic propensity for excessive aggression will be amplified given adequate reinforcement through early exposure to negative stimuli (e.g., the diathesis-stress model).
There is no linear trajectory for the unraveling of psychopathy, but a formative youth steeped in familial dysfunction certainly doesn’t minimize its probability. If the future of psychiatry and clinical neuroscience can accurately predict the likelihood of abnormal psychological development, while providing neurological course correction for those already on the psycho “path” to perdition, perhaps our voyeuristic fascination with the behaviorally incorrigible will be supplemented with an appreciation for developmental psychology and descriptive psychopathology.
*Childhood abuse and/or negligence is not always a factor in explaining adult psychopathic behavior.