The Handbook of Psychopathy (2018), edited by leading scholars in the field, is the most comprehensive, research-based synthesis of modern psychopathy science.

Notes

About the Authors:
Each chapter is authored by different experts and researchers in the field of psychoapathy and edited by Christopher J. Patrick, PhD. Patrick is a leading authority in the field of psychopathy and Professor of Psychology at Florida State University.

🙋🏼‍♂️ Lucio’s note: I re-organize chapter for topical congruency and to keep the TOC manageable.

Chapter 1. Psychopathy as Masked Pathology

Author: Christopher J. Patrick

The opening chapter, explores psychopathy through the lens of Hervey Cleckley’s classic clinical description in The Mask of Sanity (1941/1976). Cleckley’s core proposition is a masked pathology—a severe, underlying deficit in behavioral and emotional regulation concealed by a credible outward appearance of psychological normality (‘sanity’).

Main Takeaways:

The field has progressed from viewing psychopathy as a discrete condition to a dimensional and multifaceted disorder, which better aligns with the complexity Cleckley observed. The Triarchic Conceptualization (Patrick, Fowles, & Krueger, 2009) is introduced as a framework to integrate findings, characterizing psychopathy by three biobehavioral dispositions: Boldness (the “mask” or fearless dominance), Meanness (callousness-unemotionality), and Disinhibition (externalizing proneness).

• Cleckley’s 16 Diagnostic Criteria: These criteria are categorized into “Mask features” (e.g., Superficial charm, absence of delusions/nervousness, suicide rarely carried out) and “Behavioral deviance features” (e.g., Unreliability, inadequately motivated antisocial behavior, poor judgment).

Chapter 2. Psychopathy, Sociopathy, and Antisocial Personality Disorder

Author: David Lykken

This chapter was originally written by the late David T. Lykken and reprinted with William G. Iacono’s commentary. It provides a historical and conceptual analysis of the terms psychopathy, sociopathy, and Antisocial Personality Disorder (ASPD).
Lykken highlights the importance of distinguishing between a predominantly genetically-influenced, temperament-based psychopathy (sometimes called “primary” psychopathy) and a form of antisocial behavior driven more by adverse social environment (sociopathy or “secondary” psychopathy).

• Antisocial Personality Disorder (ASPD): This official DSM diagnosis primarily focuses on overt behavioral deviance (e.g., impulsivity, irresponsibility, law-breaking), correlating strongly with the Disinhibition aspect of psychopathy but not as much the core affective-interpersonal deficits (Boldness and Meanness) central to Cleckley’s psychopath.

Sociopathy vs. Psychopathy: Real-Life Examples

If Mike’s psychopathy is a result of one of the subtle brain malfunctions that are conjectured in later chapters, then even the most talented parents may be disappointed. But if Mike’s “problem” is merely that he is relatively fearless, then those parents might produce a hero instead of a hoodlum.
Some historical figures who, I believe, had the “talent” for psychopathy but who did not develop the full syndrome and achieved great worldly success include Winston Churchill (Carter, 1965; Manchester, 1986, 1988), the African explorer Sir Richard Burton (Farwell, 1963; Rice, 1990), and Chuck Yeager, the first man to fly faster than sound (Wolfe, 1979; Yeager, 1985).

And little later, Lykken includes IQ as a moderator for psychopathy, used to avoid petty crimes and instead to gain status in legitimate society. He says Lyndon Johnson exemplified this syndrome. Both Hitler and Stalin were relatively fearless, clever men, unconstrained by guilt or pity, whose ruthless rise to power would not have been possible had they felt normal degrees of caution or conscience.

🙋🏼‍♂️ Lucio’s note: This sounds appealing in its simplicity, but it also feels less convincing and authoritative. Churchill may have been high in boldness, but low in meanness and factor 2, rather than ‘talent for psychopathy’ and ‘not developing the full syndrome’.

🙋🏼‍♂️ Lucio’s Note: Little empirical evidence for parenting effects on factor 1, but valid for factor 2

From chapter 24:

Though influential theories posit that effective parenting is important for engendering success in individuals with psychopathic traits (Lykken, 1995), the empirical evidence for this proposition is mixed. Children with high levels of callous–unemotional traits—which correspond most closely to the affective facet of adult psychopathy—show high levels of conduct problems (Andershed, Gustafson, Kerr, & Stattin, 2002; Wootton, Frick, Shelton, & Silverthorn, 1997) and reactive aggression (Yeh, Chen, Raine, Baker, & Jacobson, 2011), irrespective of the measured adequacy of their parenting.

However, there is stronger evidence for factor 2:

However, for the interpersonal features of psychopathy, Lykken’s original hypothesis may hold: Adolescents high in these features who are exposed to inconsistent parenting show more deviant behavior than those experiencing consistent parenting (Edens, Skopp, & Cahill, 2008).

🙋‍♂️Lucio’s Take: A more subjective and opinionated chapter that I’d consider dropping

Lucio:
While Lykken is an authoritative voice, I found the tone of this chapter more opinionated and subjective.

The differentiation between sociopathy and psychopathy and ‘nature vs. nurture’ also felt a bit too clear-cut, including when compared to successive chapters.

Leaving the original chapter and then adding refutations based on more recent studies may also tirp some learners, who may remember the original chapter more than the more recent findings.

Overall, I’d suggest the editor consider dropping this chapter or re-author it with updated takes and studies.

Chapter 4. The Response Modulation Hypothesis

Authors: Rachel Bencic Hamilton and Joseph P. Newman

One of the most prominent cognitive models is the response modulation hypothesis (RMH). This perspective attributes the disinhibition seen in psychopathy to a failure to shift attention automatically from the implementation of ongoing goal-directed behavior to its evaluation (Newman, 1998; Patterson & Newman, 1993).

The Response Modulation Hypothesis (RMH) posits that the impulsive and problematic behavior characteristic of psychopathy stems from a weakness in the capacity to process contextual cues and redirect attention when focused on achieving a goal. Individuals high in psychopathy, when focused on a reward, fail to use peripheral or secondary information (like cues of potential punishment or danger) to modulate or adjust their ongoing behavior.

• Core Deficit: The deficit is not one of knowing right from wrong, but an attentional problem where goal-directed processing filters out contextual information that might otherwise inhibit a problematic response.
• Time and Attention Deficits: the RMH suggests that psychopathic individuals’ emotional deficits are moderated by attention. These findings suggest that the diminished reactivity to fear stimuli and affective cues seen in psychopathic individuals reflects idiosyncrasies in attention that limit the processing of information that is outside of the attentional spotlight (Newman et al., 2010).
  • Enough time and attention could cure this: when asked to turn their attention to processing and appraising the valence of emotion cues, and given enough time to do so, their performance is comparable to that of nonpsychopaths (Lorenz & Newman, 2002; see also Glass & Newman, 2009). Meffert, Gazzola, den Boer, Bartels, and Keysers (2013) presented evidence that higher-order cognitive processes moderate the empathic deficits of psychopathic individuals.
• Empathy may also be activated with directed attention & time: Meffert and colleagues suggested that when psychopathic individuals deliberately attend to empathy-related cues, they show normal empathy-related responses. It is only in situations in which the processing of empathy-related information is incidental that they show abnormalities. In our view, these findings provide evidence that the interpersonal and affective deficits characteristic of psychopathy are turned on or off depending on attentional focus (see also Ayame et al., 2014).
• Mechanism underlying Disinhibition: The RMH provides a mechanistic explanation for the Disinhibition facet of psychopathy, linking this biobehavioral trait to specific cognitive processing weaknesses.
• Two Levels of Failure: failure to pause to evaluate the potential consequences of an action promotes impulsive action and prohibits the development of behavioral control, as well as a failure to devise a long-term life plan (Factor 2). (…) failure to reflect on the negative outcome of a maladaptive action encourages dysregulated and potentially asocial behavior
• Potentially underlying emotional deficits: The paradox of psychopathy is that psychopathic individuals show the capacity for intact reasoning and ostensibly genuine affect, but when they are engaged in goal-directed behavior, the information required for these activities is less accessible (Wallace, Schmitt, Vitale, & Newman, 2000). (…) decision making and emotional deficits seen in psychopathy can be viewed as being modulated by attentional focus.

Chapter 16. Psychophysiology of Psychopathy: the Low-Fear Hypothesis

Authors: Adrian Raine (also author of ‘Psychopathy, An Introduction to Biological Findings‘), Yaling Yang

This research stream has long sought to identify a core biological mechanism, often focusing on a fundamental deficit in the ability to experience fear or respond to threat and punishment cues. However, the data are complex, leading to an integration of multiple mechanisms: one related to the Boldness/fearlessness dimension and another related to the Disinhibition/impulsivity dimension.

• Low-Fear Hypothesis: Originally proposed by Lykken and others, this hypothesis suggests that psychopathic individuals’ failure to learn from punishment or avoid danger stems from an innate, reduced emotional response (e.g., low skin conductance reactivity) to threat stimuli.
• Deficit in Defensive Reactivity: The chapter reviews evidence that high-psychopathy individuals, particularly those high in Boldness, exhibit reduced startle potentiation and other indicators of defensive (fear) reactivity.
• Integration of Mechanisms: Modern psychophysiology suggests a dual deficit: one pathway involves the low-fear temperament (affective/Boldness), and another involves deficits in inhibitory control (cognitive/Disinhibition).

Chapter 5. Temperament Risk Factors for Psychopathy

Author: Don C. Fowles

Research on psychopathy in adults has strongly documented two somewhat independent dimensions that, to a significant extent, reflect different temperament risk factors. A temperament of low fear and anxiety contributes to the first dimension, whereas disinhibition due to deficient executive control combined with high negative emotionality— tendencies indicative of general proneness to externalizing problems—appears to contribute to the second.

These two dimensions map to both to the PCL-R facets:

The two PCL-R factors are characterized as affective–interpersonal or “core features” of psychopathy (Factor 1), and impulsive–antisocial tendencies (Factor 2) (Benning, Patrick, Hicks, Blonigen, & Krueger, 2003; Hare, 1991, 2003; Harpur, Hare, & Hakstian, 1989). In personality terms, the correlation between the two factors is largely attributable to variance associated with Big Four or Big Five Antagonism (Lynam, Miller, & Derefinko, Chapter 11, this volume).

But PPI probably better captures this distinction:

Validity studies indicate considerable parallelism between PPI Factors I and II and PCL- R Factors 1 and 2, despite their differing assessment formats (e.g., Poythress et al., 2010). However, the two psychopathy factors are more clearly differentiated in the PPI, with the PPI’s Fearless Dominance factor in particular reflecting more of the positive psychological adjustment (i.e., “boldness”) aspects of psychopathy seen in Cleckley’s (1941/1976) concept of psychopathy, and less of the callous–unemotional or meanness component (see Patrick, Fowles, & Krueger, 2009, as discussed below).
(…)
Notably, in contrast with the correlated factors of the PCL-R, the two factors of the PPI are orthogonal.

Defining Temperament: Temperament is conceptualized as the heritable, early-emerging, biologically-basead and stable core of personality in affect and behavior that provides the foundation for psychopathic traits

• Temperament and Psychopathy Facets: The chapter reviews evidence for how different temperamental traits contribute to the psychopathy subdimensions:
  • Boldness (Fearlessness): This trait is linked to a lack of fear sensitivity or a low level of anxiety, which is a key temperamental factor.
  • Disinhibition (Impulsivity): This trait is linked to high levels of impulsivity and difficulty with emotional and cognitive control.
• Low fear for factor 1: Importantly, the deficit in startle potentiation was specific to F1 of the PCL-R (Patrick et al., 1993), consistent with the idea that these core features of psychopathy reflect low fear (Lykken, 1995). In contrast, aversive startle potentiation was unrelated to F2.
• PPI vs. PCL-R: The Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996; Lilienfeld & Fowler, 2006) was designed to assess psychopathy in noncriminal populations. Factor analyses of the PPI’s eight subscales (e.g., Benning et al., 2003; Benning, Patrick, Salekin, & Leistico, 2005) have revealed two higher-order factors, alternatively labeled PPI-I or Fearless Dominance, and PPI-II or Impulsive Antisociality. Notably, in contrast with the correlated factors of the PCL-R, the two factors of the PPI are orthogonal.
• Different scales reflect these two broad factors (MPQ personality profiles): a cluster analysis of MPQ for high scorers on PCL-R found two subgroups labeled “emotionally stable” and “aggressive” that paralleled the trait correlates of PCL-R F1 and F2 (Hicks, Markon, Patrick, Krueger, and Newman, 2004; Skeem, Johansson, Andershed, Kerr, and Louden, 2007)

Children With Fearless Temperament Benefit From Good Parenting & Secure Attachment

Maternal gentle discipline is enough to promote internalization of conscience in more fearful children by generating sufficient anxiety. But children with fearless temperament are harder to parent and socialize, influencing conscience development (Kochanska, 1993, 1995, 1997, 2002).
Securely attached, mutually positive mother–child relationships provide a reward-based pathway for fearless children, allowing conscience to develop without relying on anxiety (Kochanska, 1995, 1997).

Good parenting can channel a fearless child into a pro-social career.
But a fearless temperament could lead in different directions, and lack of empathy and attachment could instead produce skilled predation.
Or fearless insensitivity shaped in the directions of antagonism and callousness could give rise to high levels of meanness with extreme antisocial predation.

Externalizing Spectrum Model

The externalizing spectrum model views disinhibition (rather than strong reward-approach motivation) as the core liability (e.g., Krueger et al., 2002, 2007; Krueger & Markon, 2006). Although weak inhibitory control is central to this formulation, the deficit is viewed more broadly as one of executive control processes, including poor emotion regulation. For example, disinhibition involves “a lack of planfulness and foresight, impaired regulation of affect and urges, insistence on immediate gratification, and deficient behavioral restraint” (Patrick, 2010, p. 31), presumably related to “frontal-brain based differences in the capacity to restrain behavior and regulate affect in the service of non-immediate goals” (Patrick & Drislane, 2015, p. 629).

PART II DISTINCT PHENOTYPIC FACETS OF PSYCHOPATHY

Chapter 6. Externalizing Proneness and Psychopathy

Authors: Lindsay D. Nelson and Jens Foell

The construct of externalizing proneness, which encompasses tendencies toward impulse control problems of various types, along with affiliated traits
(…)
Externalizing proneness closely parallels the disinhibitory–behavioral (Factor 2) features of psychopathy as assessed by different instruments, which in turn relate to substance use problems. As externalizing proneness predominantly reflects behavioral disinhibition, it is distinguishable from the affective–interpersonal (Factor 1) features of psychopathy

• ESI: Scores on the ESI general Disinhibition factor showed expected robust associations with (1) a composite index of externalizing disorder symptoms, (2) broad MPQ traits of constraint and negative emotionality, known to correlate with externalizing psychopathology (Krueger, 1999a; Krueger, Caspi, Moffitt, Silva, & McGee, 1996), and (3) impulsive–antisocial (Factor 2) symptoms of psychopathy
• Genetically heritable: Genetic modeling analyses indicated that externalizing proneness (behavioral disinhibition) was highly heritable (84%), implying that a range of adolescent problem behaviors may share a common genetic etiology.
• Overlap with Other Disorders: Externalizing proneness shows substantial comorbidity with other impulse-control conditions, such as Substance Use Disorders, Conduct Disorder, and Attention-Deficit/Hyperactivity Disorder (ADHD), highlighting a shared underlying propensity for behavioral deregulation.
• Biobehavioral Referents: The chapter reviews neurobiological and cognitive processes associated with this trait, often relating to impaired reward-and-punishment sensitivity, executive function deficits, and brain systems involved in self-control.

Correlates of Externalizing Proneness

General externalizing proneness is a coherent, well-studied construct representing trait liability toward disinhibitory problems of varying kinds.
It shows broad, cross-domain associations:

Psychiatric correlates

• Strong links with substance use disorders (alcohol, cannabis, other drugs) (Nelson et al., 2016).
  • Related to cigarette smoking (Whalen et al., 2001), cannabis use (Korhonen et al., 2010), pathological gambling (Grant et al., 2016; Slutske et al., 2001), and suicidal behavior (Verona et al., 2004).
• Associated with pervasive distress internalizing disorders such as major depression, dysthymia, and generalized anxiety (Nelson et al., 2016).
• Connected to ADHD—especially hyperactive-impulsive and combined types, but not strongly to inattentive type (Barkley, 1997; Patrick et al., 2015).
• In PTSD, high externalizing predicts more antagonism, alcohol problems, and antisocial traits (Miller et al., 2003; Miller et al., 2004).

Personality trait correlates

• Negatively related to Constraint and Conscientiousness
  • Low conscientiousness predicts poorer health behaviors and life outcomes broadly (Israel & Moffitt, 2014; Moffitt et al., 2011).
• Positively related to Negative Emotionality, Neuroticism, Agreeableness deficits, and emotional instability (Griffith et al., 2010; Tackett et al., 2014).

Behavioral and cognitive correlates

The relationship between disinhibition and inhibitory control appears largely genetically mediated (Young et al., 2009).

• Linked to maladaptive decision-making and disadvantageous gambling choices (Fein et al., 2004).
• Associated with deficient executive function and response inhibition across tasks (Young et al., 2009).

Neurophysiological correlates

• Lower baseline autonomic activity but heightened stress reactivity (Lorber, 2004; Ortiz & Raine, 2004).
• Dysfunction in vagal regulation and increased striatal dopaminergic reactivity to rewards/amphetamine (Buckholtz et al., 2010a, 2010b).
• Reduced ERN amplitudes indicating poorer internal error monitoring (Hall et al., 2007).
• Most robust marker: reduced P300 amplitude across tasks, partly genetic in basis (Hicks et al., 2007; Yancey et al., 2013; Nelson et al., 2011).
• Intact processing of external feedback (FRN) but deficient elaborative processing of outcomes (Bernat et al., 2011).

Brain imaging findings

• Evidence for stimulus-driven processing style: reduced anticipatory activation and heightened amygdala reactivity to affective stimuli (Foell et al., 2016).
• Altered intrinsic connectivity involving the insula (Abram et al., 2015).
• Abnormal activation patterns during response inhibition tasks, suggesting dysfunctional reward–action coupling (Castellanos-Ryan et al., 2014).

Bottom line:
Externalizing proneness reflects a broad dispositional liability tied to poor inhibitory control, reward-driven behavior, substance problems, antagonistic outcomes, executive dysfunction, and identifiable autonomic and neural processing differences across multiple biological and behavioral systems.

Chapter 7. Callous–Unemotional Traits

Authors: Essi Viding and Eva R. Kimonis

Callous–Unemotional (CU) traits are the affective-interpersonal core of psychopathy measured in youth, characterized by lack of empathy, deficient guilt or remorse, and a general disregard for others’ feelings or problems, and at high risk for developing full adult psychopathy.
They are similar to the Meanness dimension of psychopathy in the Triarchic model.

• Core Components: CU traits encompass:
  • Lack of Empathy/Callousness: Difficulty recognizing or sharing others’ emotional states.
  • Lack of Guilt or Remorse: Failure to experience negative emotions following misconduct.
  • Shallow Affect: A limited range of emotional expression, especially warmth or positive feelings for others.
• Relevance to Youth Diagnosis: The inclusion of “with callous and unemotional traits” as a specifier for Conduct Disorder in the DSM-5 underscores the clinical and prognostic importance of Meanness in developmental psychopathology.
• CU Traits + Antisocial Factor 2 = Worst Outcomes: it is the combination of CU traits/affective dysfunction with the impulsive–antisocial behaviors captured by the Factor 2 dimension of psychopathy that designates the most severely antisocial group of youth.
• Etiological Distinction: CU traits are linked to a distinct profile of neurobiological deficits, notably an impairment in the processing of distress cues (like fear and sadness faces), suggesting a unique etiological pathway involving the amygdala and other related brain structures.

Development of Callous-Unemotional Traits

CU traits emerge from strong genetic liability interacting with the environment. The most consistent profile is:

• fearless temperament
• blunted emotional and autonomic reactivity
• reduced amygdala and empathy-network response
• impaired sensitivity to punishment and distress cues

However, positive environmental inputs—especially warm, reinforcing parenting—can meaningfully buffer genetic risk.

Genetic factors

• Moderate to strong heritability in youth (≈ .45–.67) (Viding & McCrory, 2012).
• Elevated CU is highly heritable even without conduct problems (Larsson et al., 2008).
• Conduct problems + high CU are strongly genetic, whereas conduct problems + low CU are more environmentally driven (Viding et al., 2005, 2008).
• There is partial genetic overlap between CU and externalizing, but also CU-specific genetic influences (Bezdjian et al., 2011; Forsman et al., 2008; Viding et al., 2007).
• Stability of CU traits over time is largely genetically driven (Fontaine et al., 2010; Forsman et al., 2008).

Candidate genes and molecular findings

Key principle: there are no “genes for CU”; genes influence neurocognitive vulnerabilities that raise risk.

• Tentative links involve serotonin and oxytocin systems, but replication is needed (Beitchman et al., 2012; Dadds et al., 2013; Fowler et al., 2009; Malik et al., 2012; Moul et al., 2013).
• Gene effects likely depend on environmental context (gene–environment interplay).
  Example: serotonin transporter long allele linked to CU traits in low-SES youth (Sadeh et al., 2010).
• GWAS suggest many variants of very small effect; rare variants and interactions likely important (Viding et al., 2010, 2013; Trzaskowski et al., 2013).
• Epigenetic work links higher CU to increased oxytocin receptor methylation (Cecil et al., 2014; Dadds et al., 2014).

Environmental and parenting influences

• Harsh/negative parenting → higher CU (Waller et al., 2013).
• Warm parenting → lower CU (for a review, see Waller et al., 2013).
  • High levels of adoptive mothers’ positive reinforcement were able to buffer the effects of heritable risk for CU behaviors (Hyde et al., 2016).
  • High levels of parental warmth may buffer children with high CU traits from developing serious and persistent conduct problems (Kroneman, Hipwell, Loeber, Koot, & Pardini, 2011; Pasalich, Dadds, Hawes, & Brennan, 2011; Waller, Gardner, & Hyde, 2013).
• Low affection, warmth, and positive reinforcement → increased risk for developing CU traits (Pardini, Lochman, & Powell, 2007; Pasalich, Witkiewitz, McMahon, Pinderhughes, & Conduct Problems Prevention Research Group, 2016).
• Genetic confounding likely explains part of parenting effects (Viding et al., 2009).
• Adoption study: positive reinforcement from adoptive mothers buffered genetic risk (Hyde et al., 2016).
• Children with high CU show less eye contact with mothers, suggesting child-driven effects on attachment (Dadds et al., 2011, 2012).
• Disorganized attachment is associated with CU (Bohlin, Eninger, Brocki, & Thorell, 2012; Pasalich, Dadds, Hawes, & Brennan, 2011).

Other developmental correlates

• Peer relations: more conflict and instability (Muñoz et al., 2008).
• Associate with delinquent peers (Kimonis, Frick, & Barry, 2004), but may be less influenced by them while they strongly influence others (Kerr et al., 2012).
• Possible modest negative association with IQ (Fontaine et al., 2008).
• Some links to low SES environments (Sadeh et al., 2010).
• Maternal psychopathology during/after pregnancy may be a risk factor (Barker et al., 2011).

Neurocognitive profile

Children with CU traits typically show:

• Marked lack of empathy and guilt (Frick & Viding, 2009).
• Proactive/instrumental aggression.
• Reduced attention to distress cues (fearful/sad faces) (Hodsoll et al., 2014; Marsh & Blair, 2008).
• Blunted empathy responses (Jones et al., 2010; Schwenck et al., 2012).
• Reduced eye gaze to attachment figures (Dadds et al., 2011).
• Slower behavioral change following punishment (Blair et al., 2001).

Neural correlates

Key brain findings in youth with conduct problems + CU:

• Reduced amygdala reactivity to fearful faces (Marsh et al., 2008; Viding et al., 2012).
• Low amygdala partly mediates proactive aggression (Lozier et al., 2014).
• Reduced activation in empathy network (insula, ACC, amygdala) when viewing others’ pain (Cheng et al., 2012; Lockwood et al., 2013; Marsh et al., 2013; Michalska et al., 2016; Yoder et al., 2016).
• Atypical vmPFC/OFC responses to punishment and reward (Finger et al., 2008, 2011).
• Overall pattern: low emotional responsiveness and poor reinforcement learning.

Hormonal findings

• Mixed evidence for low cortisol; results inconsistent (Hawes et al., 2009).
• Cortisol alone is likely a weak biomarker.
• Hormone coupling (cortisol–DHEA) may be more informative (Johnson et al., 2014; Kimonis et al., 2017).

Physiological markers

• Reduced skin conductance and heart rate responses to others’ distress (Blair, 1999; de Wied et al., 2012).
• Reduced autonomic reactivity during anticipation of aversive stimuli and provocation (Fung et al., 2005; Isen et al., 2010; Kimonis et al., 2008).
• Resting heart rate does not clearly differentiate CU (de Wied et al., 2012).

Early temperament

• Fearless, low-arousal temperament is a key early risk factor (Frick et al., 2014a).
• Fearlessness predicts later CU traits longitudinally (Barker et al., 2011).
• Linked to atypical development of empathy and guilt (Fowles & Kochanska, 2000).

Chapter 19. Psychopathy and Developmental Pathways to Antisocial Behavior in Youth

Authors: Paul J. Frick and Monica A. Marsee

Callous–Unemotional (CU) Traits related to psychopathy in youth and their presence identifies a severe, stable, and highly problematic subgroup of youth with conduct problems who are prone to proactive aggression and display an unperturbed, “cold” manner. Understanding the antecedents of CU traits is essential for early identification and targeted intervention.

• Antecedents and Early Markers: The chapter reviews prospective studies that identify early markers of CU traits, such as blunted affect, reduced attention to eyes/fear cues (Dadds et al., 2006, 2008, 2011), and the early use of proactive, instrumental aggression (Salekin & Lynam, 2010).
• Parents may be crucial to develop guilt/conscience in behaviorally disinhibited children: behaviorally inhibited children, because they are temperamentally predisposed to develop appropriate levels of guilt, may need less optimal parenting than fearless and behaviorally uninhibited children.
  In a sample of preschool children (ages 3–5), behaviorally inhibited children showed higher levels of guilt, irrespective of the consistency of parenting, while uninhibited children only with high parental consistency (Cornell and Frick, 2007)
• Proactive vs. Reactive Aggression: CU traits are selectively related to proactive (instrumental) aggression—aggression used deliberately to achieve a goal—rather than reactive aggression, which is impulsive and hostile.
• Developmental Trajectory: The stability of CU traits from early childhood into adolescence suggests they are a reliable, enduring marker of a psychopathic-like developmental pathway.

Chapter 8. Boldness: Conceptual and Methodological Issues

Authors: Scott O. Lilienfeld, Ashley L. Watts, Sarah Francis Smith, and Robert D. Latzman

Boldness, similar to fearless dominance, is a unique, often adaptive, trait characterized by social charm and confidence, low stress reactivity, a lack of fear, high self-assurance, and a tendency toward social dominance. It distinguishes individuals high in psychopathy who are “successful” (i.e., less prone to apprehension and incarceration) from those who are “unsuccessful” and is often negatively correlated with measures of anxiety and neuroticism.

• Key Component Traits: interpersonal potency, charisma, physical fearlessness, venturesomeness, and novelty seeking, along with calmness in the face of danger.
• Brain’s lower defensiveness: Although the etiology of boldness remains the subject of debate, Patrick and colleagues (2009) conjectured that it stems from individual differences in the sensitivity of the brain’s defensive systems, including those rooted in the amygdala and other structures involved in threat processing (see LeDoux, 2015, for a discussion).
  • consistent with the hypothesis that boldness is associated with lower sensitivity to perceived danger. Taken together, these diverse findings point to a low level of responsiveness in the defensive system among individuals with elevated levels of boldness (see also Watts, Lilienfeld, DeMartino, & Sauvigné, 2015, for preliminary meta-analytic evidence).
• The “Successful Psychopath” Link: Boldness is a key differentiator in the successful psychopathy literature (see Chapter 24), as it is hypothesized to confer resilience, intact executive function, and the ability to navigate complex social situations without the debilitating fear and anxiety that characterize others.
• Behavioral Dishinhibition: Miller and Lynam (2012) reported that FD was associated primarily with (reversed) FFM Neuroticism (r,, = -.50), FFM Extraversion (r,, = .50), and, to a lesser extent, FFM Openness to Experience (r,, = .25); associations with FFM Agreeableness and Conscientiousness were negligible. Consistent with the conjectures of Fowles (1980) and Lykken (1995), FD was highly and negatively associated with measures of behavioral inhibition (r,, = —.57). Its associations with measures of behavioral activation were weaker but nonetheless positive and moderate positive in magnitude (rw = .35).
• Measurement and Correlates: The chapter discusses the various ways Boldness is assessed (e.g., through the Triarchic Psychopathy Measure [TriPM] or the Psychopathic Personality Inventory [PPI]) and its contrasting correlates, noting that it often relates negatively to internalizing psychopathology like anxiety.
• Methodological Challenges: The authors address the complexities of separating Boldness from traits like Narcissism and examining its role in different populations.

Boldness and Interpersonal Behavior

Research increasingly links boldness (as assessed by Fearless Dominance, FD) to adaptive interpersonal traits such as leadership, heroism, and social influence.
Lilienfeld, Waldman, and colleagues (2012) found that higher FD predicted historians’ ratings of leadership, communication, public persuasiveness, willingness to take risks, legislative initiative, landslide election wins, and global stature, though it was also associated with assassination attempts.

In workplace and community samples, FD was positively associated with adaptive leadership styles, such as transformational leadership, and minimally related to counterproductive or domineering behaviors (Smith & Lilienfeld, 2012; Smith, Watts, & Lilienfeld, 2017). Across a large multinational sample, FD also predicted holding leadership and management positions, as well as risky occupations like police, fire, and military work (Lilienfeld, Latzman, Watts, Smith, & Dutton, 2014).

Consistent with Lykken’s (1982, 1995) idea that heroes and fearless psychopaths share low dispositional fear, FD was positively associated with everyday heroism (e.g., helping strangers in risky situations) and altruism toward strangers in undergraduate and community samples (Smith, Lilienfeld, Coffey, & Dabbs, 2013). Similarly, presidential war heroism correlated with estimated FD scores, with leaders like Theodore Roosevelt and Zachary Taylor scoring high. Overall, these findings suggest that boldness relates to prosocial behaviors that involve social or physical risk, rather than prosocial behavior in general.

🙋‍♂️Lucio’s Take: Is heroism only adaptive within a limited range?

Lucio:
I wonder about the true extent of heroism’ ‘adaptiveness’, at least in evolutionary psychology term of fitness (survival and reproduction).

Heroism is adaptive when it boosts a man’s status, but if he pushes his ‘heroic luck’ too far, then… Dead heroes leave no offspring.

That makes me wonder if heroism may be on an inverted U of adaptiveness, and only fitness-enhancing within an optimum range and with strategic calibration (ie.: be heroic when the risks are not too high and it makes you look like a hero, but avoid too high risks).

Boldness Primarily Differentiates ASPD From Psychopathy

As noted earlier, the results of two recent studies (Venables et al., 2014; Wall et al., 2015) demonstrate that boldness is a primary, if not the primary feature differentiating psychopathy, as measured by the PCL-R, from ASPD (see also Murphy, Lilienfeld, Skeem, & Edens, 2016).
These findings dovetail with the longstanding historical view that psychopathy is more associated with adaptive functioning, including superficial charm, dominance, and psychologically healthy risk-taking, than is ASPD (Lilienfeld et al., 2015a).

The association between boldness and 11 non-PCL-based measures of psychopathy across 32 samples (N = 10,693) found a considerably high mean effect size (r = .38), and when the analyses were restricted to well-validated psychopathy measures, the mean effect size rose to r = .44 (Lilienfeld et al., 2016).

🙋🏼‍♂️ Lucio’s note: This makes sense, so I had to wonder if it isn’t also correct to say that the broader factor 1 differentiates them

Is Boldness a Core Feature of Psychopathy?

the nature of boldness and its relevance to psychopathy have recently become flashpoints of intense scientific controversy (Lilienfeld, Patrick, et al., 2012; Lynam & Miller, 2013; Miller & Lynam, 2012; Patrick, Venables, & Drislane, 2013). In particular, experts in the field have debated whether boldness is an intrinsic feature of psychopathy, or is instead irrelevant or at best peripheral to it. Perhaps boldness is not part of psychopathy per se but only moderates its behavioral expression, predisposing individuals to “successful” or 179 “adaptive” psychopathy (Hall & Benning, 2006; see also Lynam & Miller, 2013; Widom, 1977).

Is Boldness Truly Adaptive?

Moreover, the question of whether boldness is entirely psychologically adaptive or, like other features of psychopathy, it also has a dark side (Paulhus & Williams, 2002), remains a point of contention. Perhaps when dispositional boldness becomes too extreme or when it is coupled with certain unsavory personality traits, such as poor impulse control or antagonism, or certain cognitive traits, such as low intelligence or poor executive functioning, the right stuff can transmute into the wrong stuff, crossing the murky boundary that separates bravery from reckless risk taking.

The authors also argue that Boldness alone is usually not harmful. It tends to become maladaptive when combined with high SCI (Lilienfeld et al., 2015a; Lilienfeld, Watts, & Smith, 2016).

With intact executive control, boldness can produce the “right stuff” (Wolfe, 1979). But when paired with poor executive functioning, it is more likely to channel into poorly judged risk-taking (Frost, Ko, & James, 2007; James, 2008).

Empirical work supports this interaction: the combination of high FD and high SCI predicts outcomes such as predatory aggression (Smith, Edens, & McDermott, 2013), sexual risk taking (Kastner & Sellbom, 2012), and negative affect after risky sexual behavior (Fulton et al., 2014).

Boldness May Follow the Law of Optimum Balance

The authors conclude that very low levels of are tied to elevated risk for internalizing disorders, but we don’t have enough data yet to say whether too much boldness becomes similarly maladaptive.
More data is needed to conclude whether boldness follows the law of balance.

FD and SCI Differences

Taken together, these studies paint a picture of FD as being negatively associated with conditions marked by emotional distress, and positively associated with healthy adjustment.

Just like for factor 1 and 2 from the PCL-3, FD and SCI from the PPI displayed strikingly different psychopathological correlates.
that only SCI was significantly associated with substance and drug abuse, and consistently positively associated with a host of measures of childhood and adult antisocial behavior. In contrast, FD was essentially unrelated to childhood antisocial behavior, although it was slightly but significantly associated with interview-assessed adult antisocial behavior (r = .15).

PART III ASSESSMENT AND DIAGNOSIS OF PSYCHOPATHY

I move chapter 3 here for topical congruency

Chapter 3. The PCL-R Assessment of Psychopathy: Development, Properties, Debates, and New Directions

Authors: Robert D. Hare, Craig S. Neumann, and Andreas Mokros

The authors review the Psychopathy Checklist-Revised (PCL-R; Hare, 2003), which is considered the most established and empirically-supported measure of psychopathy for use with adult offenders. Its extensive use has led to a large body of research supporting the disorder’s forensic utility.

The PCL-R’s structure is multifaceted, yielding a two-factor, three-factor, or four-factor model of psychopathy.
Associated versions have also been developed for adolescents, screening versions, and self-report instruments (e.g., PCL:YV).

• PCL-R structure: The PCL-R is an interview-based, file-reviewed measure that focuses on criminal psychopathy and is uniquely useful in offender samples due to its strong predictive validity for criminal behavior.
• Multifactorial Structure: The PCL-R structure is typically described by:
  • Factor 1 (Interpersonal/Affective): Captures the core personality traits (e.g., superficial charm, pathological lying, lack of empathy), aligning with the Boldness and Meanness aspects of the Triarchic model.
  • Factor 2 (Lifestyle/Antisocial): Captures the chronic behavioral instability and deviance (e.g., impulsivity, juvenile delinquency, criminal versatility), aligning with the Disinhibition aspect.

🙋🏼‍♂️ Lucio’s note: Hare and possible bias with PCL-R
while it may seem most befitting to have Robert Hare author this chapter, there may be downsides to it, including conflicts of interest, potential bias, and a less-than-truly representative chapter. I would have liked to see more about the issues around the PCL-R, including criminal behavior, but I was left hoping for more. See the notes below for more details

Chapter 9. Capturing Psychopathic Personality: Penetrating the Mask of Sanity through Clinical Interview

Authors: David J. Cooke and Caroline Logan

Due to the psychopathic individual’s superficial charm, manipulative tendencies, and pathological deceitfulness, interview-based assessment must go beyond self-report to gather objective, observable information. The authors advocate for a comprehensive, information-based approach to assessment that integrates data from collateral sources and uses a structured conceptual model, such as the Comprehensive Assessment of Psychopathic Personality (CAPP), to ensure all facets of the construct are covered.

• The “Mask” Challenge: Psychopathy is a disorder that cannot be observed only in a clinical setting; the true pathology is revealed only when observing the individual’s history of real-life activity in “the marketplace, the saloon… to church, and to their work” (Cleckley, 1976).

Chapter 10. The Self-Report Assessment of Psychopathy: Challenges, Pitfalls, and Promises

Authors: Martin Sellbom, Scott O. Lilienfeld, Katherine A. Fowler, and Kristen L. McCrary

While self-report measures are highly cost-effective and capture subjective experiences not easily observable (e.g., thoughts, emotions), they are vulnerable to the psychopathic traits of lying, deception, and impression management. However, modern self-report instruments are increasingly valuable for assessing specific facets, particularly the Boldness/Fearless Dominance factor, which often correlates negatively with anxiety and is captured well by an individual’s self-perception of fearlessness and confidence.

• Challenges: The primary pitfall is the risk of faking bad (over-reporting negative traits) or faking good (under-reporting negative traits, especially the affective/interpersonal components) due to the manipulative nature of the psychopathic individual.
• Mean and exploitative were worse at faking tests: those scoring high on the meanness (i.e., callous–unemotional, exploitative–aggressive) domain of psychopathy were worse at avoiding detection by scales designed to identify underreporting than those who scored low on this domain.
• Psychopathy is a configuration of largely independent traits: The interview-based PCL-R also includes separable factors, further divisible into facets (Hare, Neumann, & Mokros, Chapter 3, this volume) that show strongly divergent associations with criterion measures in self-report, clinical-diagnostic, behavioral, and physiological response domains. Rather than a classical syndrome, which, as noted earlier, comprises a constellation of covarying signs and symptoms (Kazdin, 1983), psychopathy may instead be a maladaptive configuration of largely independent dimensions.
• New may be needed for what seems a configural construct: This alternative view of psychopathy as a configural condition may call for alternative models of scoring and interpreting self-report psychopathy measures. Scholars may need to consider configural (multiplicative or interactive) models of scoring self-report psychopathy measures instead of, or at least in addition to, more traditional linear (additive) models that rely on merely summing scores on lower-order psychopathy dimensions.
• Meanness and antagonism as core components: A compelling argument can perhaps be made for the essentiality of meanness or antagonism in differing manifestations of psychopathy (Lynam, Miller, & Derefinko, Chapter 11, this volume; see also Crego & Widiger, 2015; Lynam & Miller, 2015).
  • But boldness differentiates between ASPD and psychopathy: However, there is evidence that the boldness domain, which maps onto many of the features of psychopathy described by Cleckley (1976; see Lilienfeld et al., Chapter 8, and Patrick, Chapter 1, this volume), differentiates psychopathy from DSM ASPD (Venables et al., 2014; Wall et al., 2015), and consistently distinguishes primary from secondary psychopathy in subtype studies (Hicks & Drislane, Chapter 13, this volume).

Best quote

The psychopath shows a remarkable disregard for truth and is to be trusted no more in his accounts of the past than in his promises for the future

Chapter 11. Psychopathy and Personality: Benefits of a Trait-Based Approach

Authors: Donald R. Lynam, Joshua D. Miller, and Karen J. Derefinko

Conceptualizing psychopathy in terms of broader personality dimensions, like the FFM (Neuroticism, Extraversion, Openness, Agreeableness, Conscientiousness), links psychopathy research to the massive existing research base in general personality science. This approach simplifies the construct by showing that psychopathy is primarily characterized by a severe lack of Agreeableness and Conscientiousness.

• Five-Factor Model (FFM) Mapping: The chapter demonstrates how the psychopathy traits align with the FFM:
  • Meanness/Antagonism aligns with very low Agreeableness.
  • Disinhibition aligns with very low Conscientiousness.
  • Boldness is often linked to high Extraversion and low Neuroticism (fearlessness).
• Benefits of Trait-Based Approach: Using this framework allows researchers to study developmental change, cross-cultural differences, and basic psychological processes (e.g., those underlying Agreeableness) related to psychopathy using established methodologies.

🙋🏼‍♂️ Lucio’s note: I agree with the author and it was an incredibly instructive chapter. My only note was that at times I felt the FFM-based approach may be stretched to fit certain facets or aspects of psychopathy. For example, referring to ‘extraversion minus trust’ is not describing FFM extraversion anymore, but something different. This is why other measures of psychopathy are equally relevant.

Chapter 12. Psychopathy and DSM-5 Psychopathology

Authors: Thomas A. Widiger and Cristina Crego

While the DSM-5 maintains the behavioral-centric diagnosis of Antisocial Personality Disorder (ASPD) in its categorical section, it introduced an Alternative Model for Personality Disorders (AMPD) that better captures the full spectrum of psychopathic personality. The AMPD’s trait-based approach, which includes the domain of Antagonism and the facet of Callousness, aligns more closely with the interpersonal and affective features (Meanness and Boldness) that are often missed by ASPD alone.

• ASPD Limitations: The established DSM criteria for ASPD are heavily skewed toward observable antisocial behaviors (Disinhibition), leading to a diagnosis that is broader than psychopathy and fails to distinguish between the primary (affective/interpersonal) and secondary (anxious/reactive) variants.
• Dishibitory liability is the genetic foundation: psychopathy, ASPD, substance use disorder, and low Conscientiousness (or low constraint) may all reflect a common, underlying disinhibitory liability. Consistent with this, twin studies have suggested a common genetic basis to ASPD, substance use disorders, and low Conscientiousness (Sher & Slutske, 2003).
• There are more antisocials than psychopaths: Antisocial Personality Disorder There has been a considerable body of research on the diagnostic co-occurrence of psychopathy with antisocial personality disorder (ASPD). This research has generally suggested that most cases of psychopathy diagnosed within prison or other forensic settings would meet DSM-IV (APA, 2000) criteria for ASPD (which were carried forward into DSM-5; see below), but only about half of the cases of ASPD would meet criteria for psychopathy (Hare, 2003; Hare & Neumann, 2008).
• The AMPD Framework: The Alternative Model is trait-based and organizes personality pathology along domains, where psychopathy is best represented by a high score on the Antagonism domain (corresponding to Meanness) and a low score on the Conscientiousness domain (corresponding to Disinhibition).
• Youth Diagnosis: The chapter also addresses the inclusion of the “with callous and unemotional traits” specifier for Conduct Disorder in the DSM-5, which helps to identify the high-risk, psychopathic variant of youth antisociality.

Criminal vs. Antisocial: Non-criminal ≠ ‘Good’

An interesting distinction between ‘criminal’ vs ‘antisocial’ that’s relevant to the discussion of ‘adaptive vs. maladaptive’ psychopathy

Although it is not difficult to imagine a psychopathic person without a criminal record or even a criminal history, it is perhaps difficult to imagine a psychopathic person not having a history infused with unethical, predatory, and other disreputable acts. Skeem and Cooke (2010) made a distinction between criminal and antisocial behavior. “Criminal” behavior is sanctioned by the legal system, whereas “antisocial” behavior is more inclusive, involving “behavior that defeats the interests of the social order” (p. 435). “Snakes in suits” (i.e., psychopathic persons in business, law or other white-collar professions; Babiak & Hare, 2006; Babiak, Newmann, & Hare, 2010) may not in fact break many laws, but they significantly bend, massage, and work the rules to an unfair, self-serving advantage.

Chapter 13. Variants (“Subtypes”) of Psychopathy

Authors: Brian M. Hicks and Laura E. Drislane

The idea of psychopathy subtypes (e.g., Primary vs. Secondary, or variants based on the Triarchic factors) reflects growing evidence that different configurations of underlying traits exist, which have distinct etiological origins, personality correlates, and clinical implications. The primary distinction focuses on the role of anxiety/fear.

Factor 1 vs. Factor 2 Table

🙋🏼‍♂️ Lucio’s note: this table is my own, compiling a collection of studies from this chapter, as well as other studies from other chapters

Note: many of these associations are only clearly evident after controlling for the variance in Factor 1 that overlaps with Factor 2 (Blonigen et al., 2010; Harpur et al., 1988; Hicks & Patrick, 2006; Patrick, 1994; Smith & Newman, 1990; Verona et al., 2001, 2005).

Factor 1 vs. Factor 2

• Primary Psychopathy: Characterized by high psychopathic features, low trait anxiousness, a “cold” and calculated behavioral style, and often aligns with the Boldness trait. This subtype is theorized to stem from a core affective deficit.
• Secondary Psychopathy (Sociopathy): Characterized by comparable levels of antisocial behavior but higher trait anxiousness, strong negative emotions, and a “hot” or reactive and impulsive behavioral style. This subtype is often linked to neurotic conflicts and severe environmental factors like child maltreatment.

PCL-R factor 1 and 2 have a correlation of .50, while the PPI’s factors termed Fearless Dominance and Self-Centered Impulsivity (Lilienfeld & Widows, 2005; alternatively labeled Impulsive Antisociality [Benning et al., 2003]) do not.

However, their nomological networks are markedly similar when researchers control for their shared variance (Benning, Patrick, Blonigen, Hicks, & Iacono, 2005; Poythress et al., 2010).

The largest difference between the primary and secondary subtypes on personality traits was for Neuroticism (d = 1.28), followed by Anger/Aggression (d = 0.75). Consistent with the notion of a severe subtype of ASPD or externalizing subtype, the secondary variant also scored higher on Disinhibition than the primary variant (d = 0.60). The primary subtype, however, was higher on Positive Emotionality/Extraversion (d = 0.70) than the secondary subtype, consistent with the conceptualization of good adjustment and greater social poise and engagement.

In general, factor 2 is messier and more problematic, with elevated levels of both internalizing and externalizing problems.
But findings for the relationship between psychopathy subtypes and criminal behavior were mixed.

• No neurological subtypes yet: Ideally, the defining features of subtypes would be directly relevant to etiology, for example, features reflecting emotional or cognitive processes whose neurobiological pathways are well mapped. No such defining features have been established for psychopathy. Therefore, psychopathy subtypes are typically defined by differences on an array of traits and clinical features that we refer to here as ‘personality structure’
• Triarchic Subtypes: Patrick and colleagues (2009) proposed a triarchic model of psychopathy that seeks to synthesize multiple theoretical approaches and lines of empirical research proposing that different combinations of Boldness, Meanness, and Disinhibition can define distinct variants.
  evidenced by validation studies utilizing the TriPM (…) has substantial descriptive utility for comparing different conceptions of psychopathy based on how prominently Boldness, Disinhibition, and Meanness are represented.
• Low boldness and high disinhibition had highest externalizing and psychological adjustment: analyzing results from the Minnesota Twins, Hick’s intringuing findings suggest that individuals with high scores on Boldness and Disinhibition represent an extreme externalizing subgroup that lacks typically co-occurring internalizing problems. This lack of internalizing problems may in fact facilitate engagement in antisocial deviance. It is interesting to note that persons with high Boldness and low Disinhibition scores exhibited the lowest rates of psychopathology and highest levels of psychosocial adjustment (Hicks, 2014).
  • Boldness + disinhibition is the issue: boldness per se is not associated with psychopathology. Rather, Boldness appears to act as a moderator of disinhibitory tendencies, such that the combination of the two yields a distinct subsample that exhibits very high levels of antisocial deviance (i.e., an “externalizing supergroup”), while maintaining relatively stable emotional adjustment and competent interpersonal functioning.
• ASPD is low constraint and negative emotionality: the ASPD criteria do identify a relatively severe psychiatric condition that has strong personality correlates, most notably high negative emotionality (aggression, alienation, stress reactivity) and low constraint (Krueger, Caspi, Moffitt, Silva, & McGee, 1996). The personality profile associated with ASPD seems to be driven by the small group of people (nearly all men) within the general population whose antisocial behavior exhibits an early onset and persistent course.

Chapter 14. Genetic and Environmental Influences

Authors: Irwin D. Waldman, Soo Hyun Rhee, Devon LoParo, and Yunsoo Park

Psychopathy and antisocial behavior are influenced by a complex interplay of heritable factors (genes) and specific environmental factors, often studied through twin and adoption studies. Crucially, the different facets of psychopathy show distinct heritability patterns, confirming the need to study psychopathy as a multifaceted construct with diverse etiological roots.

• High Heritability: The chapter details evidence suggesting that general antisocial behavior and personality traits underlying psychopathy (e.g., low empathy, fearlessness) have a significant heritable component.
• Genes and non-shared environments account for the lion’s share: Meta-Analysis Results The results of analyses of data from all of the samples meeting the inclusion criteria (N = 52 samples; 149 groups; 55,525 pairs of participants) are presented in Table 14.1. The full ACDE model fit best as compared with the other, more restrictive models, suggesting that additive genetic (32%), nonadditive genetic (9%), shared environmental (16%), and nonshared environmental influences (43%) have significant influences on antisocial behavior. Parameter estimates did not differ after excluding studies that examined psychopathy
• Environment still matters (from chapter 31): although identical twins exhibit increased similarity for levels of psychopathic features compared to fraternal twins, the concordance they show in absolute terms is moderate rather than high—indicating a substantial contribution of environmental influences (and their interplay with genomic makeup) to the emergence and expression of psychopathic symptoms across time.
• Facet-Specific Etiology:
  • Callous–Unemotional (Meanness) Traits: Show a particularly strong heritable influence, suggesting a significant innate, biological vulnerability for the core affective deficits.
  • Impulsivity/Disinhibition: Also shows a strong genetic component but is more reactive to specific non-shared environmental influences.
• Gene-Environment Interplay: The authors explore the concepts of gene-environment correlation (where genetic predispositions influence the environments an individual seeks or is exposed to) and gene-environment interaction (where a genetic risk factor is only expressed under certain environmental conditions, such as early maltreatment).

Chapter 15. Family Background and Psychopathy

Authors: David P. Farrington

Adverse family and social environments, while not the sole cause, is an important exacerbating factor, especially for the behavioral and disinhibited aspects of psychopathy. Poor parenting, family disruption, and exposure to deviant models significantly increase the risk for an individual with a biological vulnerability (e.g., low fear, high impulsivity) to progress toward a psychopathic outcome.

• Real but small effect sizes: Leschied, Chiodo, Nowicki, and Rodger (2008) conducted a comprehensive meta-analysis of 38 prospective longitudinal studies in which the focus was to establish which, if any, family factors were related to later criminality and antisocial behavior. Taken together, the family factors measured (e.g., parental discipline, substance and child abuse, and family separation) had an effect size (Cohen’s d) of 0.25.
  • Effects vary by developmental period: effects of family predictors varied somewhat over time and across developmental periods. For example, family structure appeared to have a greater effect when measured in adolescence (d = 0.67, p < .01), whereas parental management assessed during mid-childhood (d = 0.41, p < .001) was most strongly predictive of adult antisociality. These latter findings suggest that the effects of some family factors may be specific to certain developmental periods, which could potentially account for weak relationships reported in other studies focusing on only one specific period of development (Leschied et al., 2008).
• There are 7 family factors: family factors are grouped into seven categories: (1) childrearing problems (poor supervision, poor discipline, coldness and rejection, low parental involvement with the child); (2) abuse (physical or sexual) or neglect; (3) parental conflict and disrupted families; (4) large family size; (5) criminal or antisocial parents or siblings; (6) other characteristics of parents (young age, substance abuse, stress, anxiety/depression); and (7) socioeconomic factors (e.g., low income, poor housing).
• Keep an eye on your children: studies show that parents who do not know where their children are when they are out, and parents who let their children roam the streets unsupervised from an early age, tend to have delinquent children.
• Urbanization boosts criminality: boys living in urban areas are more violent than those living in rural ones (Derzon, 2010; Foster & Brooks-Gunn, 2013). In the U.S. National Youth Survey, the prevalence of self-reported assault and robbery was considerably higher among urban youth (Elliott et al., 1989). Within urban areas, boys living in high-crime neighborhoods are more violent than those living in low-crime neighborhoods.
• Key Risk Factors: Several different factors affect outcomes
  • Parental Antisociality/Criminality: Transmission of deviance through both genetic and social learning mechanisms.
  • Parenting Practices: Factors like harsh, inconsistent, or neglectful parenting significantly contribute to externalizing behaviors.
  • Family Disruption: Socioeconomic deprivation, large family size, and family conflict are often associated with increased risk for youth conduct problems.
• Environmental Impact on Subtypes: Poor environmental factors are especially implicated in the development of Secondary Psychopathy (sociopathy), where anxiety and negative emotion are higher, often stemming from trauma or dysfunctional parenting.

Chapter 17. Psychopathy and Brain Function: Insights from Neuroimaging Research

Authors: Blair, Meffert, Hwang, and White

Neurobiological research has consistently pointed to structural and functional abnormalities in brain regions responsible for emotional processing, social cognition, and impulse control, offering insights into the biological underpinnings of psychopathic traits.

• Amygdala Dysfunction: The chapter highlights consistent evidence for functional and sometimes structural abnormalities in the amygdala, a region crucial for fear conditioning and processing distress cues. This dysfunction is strongly linked to the Meanness (Callous-Unemotional) trait.
• Prefrontal Cortex (PFC) Abnormalities: Deficits are often observed in the ventromedial prefrontal cortex (vmPFC) and orbitofrontal cortex (OFC), which are involved in response reversal, inhibitory control, and evaluating consequences. These findings provide a neural basis for the Disinhibition and poor judgment aspects.
• Integration with Mechanisms: Neuroimaging provides a clear biological referent for understanding mechanisms like reduced empathy, impaired fear conditioning, and poor decision-making capacity.

Chapter 18. Cognitive and Emotional Processing in Psychopathy

Author: Christopher J. Patrick

The triarchic model of psychopathy (Patrick et al., 2009) (…) encompasses three distinct dispositional tendencies that account for its observable symptoms and correlates: boldness, involving social dominance, emotional stability/resilience, and venturesomeness; meanness, entailing deficient empathy (callousness), selfishness, and aggressive exploitation of others; and disinhibition, involving lack of behavioral restraint, irresponsibility, and emotional volatility. The TriPM was developed to assess psychopathy in terms of these distinct dispositions.

The chapter ties together the different parts of the book by using three core psychological processes—inhibitory control, defensive (fear) reactivity, and empathic sensitivity—as conceptual anchors for the three Triarchic traits. This integrative perspective shows how specific deficits in these processes map directly onto the clinical manifestation of Boldness, Meanness, and Disinhibition.

• Three Key Processes and Triarchic Links:
  • Inhibitory Control: Deficits in this area (e.g., in executive function) are strongly linked to Disinhibition.
  • Defensive (Fear) Reactivity: Impaired or low reactivity to threat is the mechanism underlying Boldness (fearless dominance).
  • Empathic Sensitivity: Deficient processing of others’ emotional states is the mechanism underlying Meanness (callousness-unemotionality).
• Continuously varying dimensions: The empirical evidence for disinhibition, boldness, and meanness as continuously varying, polygenic dispositions lends credibility to the idea that liabilities for the three can occur in varying combinations.
• Dishibition = externalizing: the disinhibition construct of the triarchic model corresponds to the externalizing liability factor in the general psychopathology literature (Krueger et al., 2002, 2007), and it has well-established behavioral and neurophysiological correlates.
• Social attachment and empathy are linked: Decety (2011) drew attention to empirical evidence for a connection between social attachment and capacity for empathic concern, including evidence pointing to shared neural circuitry for these two processes. In doing so, he highlighted the role of neurochemical systems in the regulation of attachment behavior, with a particular emphasis on the neuropeptide oxytocin
• Continuous, not discrete: evidence strongly supports the view of psychopathy as continuous in nature (i.e., varying by degree across individuals) rather than discrete (i.e., either present or absent).
• Agentic disaffiliation = goal pursuit without empathy: standard attachment-style inventories are not well suited to indexing the weak social connectedness that characterizes classically “detached” psychopathic individuals, as distinguished from affectively dysregulated externalizing individuals (Hicks & Drislane, Chapter 13, this volume). The triarchic model characterizes the social deficit in psychopathy as active (“agentic”) disaffiliation —involving pursuit of goals/resources without concern for the feelings or welfare of others (Patrick et al., 2009).
• Bridging Phenotype and Genotype: The chapter demonstrates how these processes can be assessed behaviorally (phenotype) and linked to specific neurobiological systems (genotype), fulfilling the mandate of the NIMH Research Domain Criteria (RDoC) framework.

Affective Deficits + Low Control = Impulsive Disregard

To the extent that individuals are deficient in control system function and lacking as well in fear of aversive outcomes, sensitivity to others’ distress, or feelings of closeness/connectedness, their propensity to act in the moment without regard for consequences will be high. When affective deficits are present, only moderate levels of disinhibitory liability may be required to produce a reckless, unrestrained behavioral orientation. This may help to account for why many psychopathic individuals do not show impaired performance on behavioral tests of frontal executive function.

PART V PSYCHOPATHY IN SPECIFIC SUBPOPULATIONS

Chapter 20. Psychopathy in Children and Adolescents

Authors: Randall T. Salekin, Henrik Andershed, and Abby P. Clark

Our review of the youth psychopathy literature indicates that the interpersonal, affective, and behavioral features of psychopathy are present and measurable quite early in life.
(…) multidimensional psychopathy measures developed for use with children and adolescents do, for the most part, index a condition that appears similar to adult psychopathy, and that psychopathic tendencies identified early in life have a genetic basis and are relatively persistent across time.
(…)
available research indicates that psychopathic tendencies in youth are predictive of more severe antisocial–aggressive outcomes, but that psychological treatment has potential to ameliorate the condition early in its development.

• Differences are evident from young age: research findings to date indicate that early on, pathological levels of these symptoms are also evident (Evans & Lee, 2013; Lewis, Stanger, & Sullivan, 1989; Parry, 2006; Peskin, 1992; Talwar & Crossman, 2011). Research has shown that even young children can dominate others excessively (Assary, Salekin, & Barker, 2015), tell strategic lies (Evans, Xu, & Lee, 2011; Fu, Evans, Xu, & Lee, 2012), and deliberately mislead others (Hsu & Cheung, 2013; Polak & Harris, 1999). Moreover, the differences between age-normative lying and more pathological forms of deceptiveness may emerge early in development (Waller et al., 2012). Past research has shown that even in preschoolers, a smaller subset of children can be identified and seen by others as chronic liars (Stouthamer-Loeber, 1986).
• Heightened risk-taking is visible early on: Although engagement in some risky behavior may be common among children (Sandseter & Kennair, 2012), emerging research on this topic suggests that variation in such behavior is possible to assess at a very young age, with certain youth being quite high in risk-taking and others being distinctly low (Morrongiello & Lasenby, 2006). For example, in a study that evaluated children ages 2–5 years for sensation-seeking tendencies, Morrongiello and colleagues (2012) found that very young “daredevils” could be reliably identified.
• Environment can channel psychopathic traits in very different directions: research has shown that parenting and other environmental factors may affect the manner in which impulsive/sensation-seeking tendencies are expressed. For instance, within affluent neighborhoods, high impulsivity or sensation seeking might lead to engagement in high-risk sports and adventuresome prosocial pursuits, whereas within less affluent neighborhoods, these same traits could give rise to delinquency, substance use, and other problems (Barker, Trentacosta, & Salekin, 2011).
• Extreme self-worth and beliefs of superiority predict proactive aggression and ringleader bullying (e.g., Ang, Ong, Lim, & Lim, 2010; Barry et al., 2007; Bukowski, Schwartzman, Santo, Bagwell, & Adams, 2009; Kerig & Stellwagen, 2010; Stellwagen & Kerig, 2013; Washburn, McMahon, King, Reinecke, & Silver, 2004) and the interpersonal features of psychopathy were associated with better perspective taking and were more predictive of ringleader bullying than either CU traits or impulsivity.
• Interpersonal manipulativeness is related to aggression and reduced prosocial behavior in young children (Pauletti, Menon, Menon, Tobin, and Perry, 2012)

22. Cultural and Ethnic Variations in Psychopathy

Authors: Kostas A. Fanti, Alexandros Lordos, Elizabeth A. Sullivan, and David S. Kosson

In summary, available research findings indicate that psychopathy is similar in many respects across cultures.

• Slightly higher scores for African Americans? Some studies pointed out to higher scores for African American in the US, but Skeem, Edens, Camp, and Colwell (2004) compared mean PCL-R scores for African American and European American participants across 21 studies and found a small but significant Cohen’s d for PCL-R total scores (d = 0.11, SD = .23), and for scores on the Affective (d = 0.10, SD = .20) dimension of psychopathy. But didn’t find differences for Factor 1, leading them to conclude that there is no strong evidence that African Americans have higher levels of the core psychopathic traits than European Americans. However, the heterogeneity and the variability in the range of differences in mean total PCL-R scores across ethnic groups (from +3.3 to –4.7) indicate substantial ambiguity.
  Verona and colleagues (2010) suggest that reported ethnic differences might actually be an artifact of SES.
• Some differences among ethnicities exist: There do appear to be relatively consistent differences between African Americans and European Americans in relationships of psychopathy scores with some criterion variables, in particular with self- reported Impulsivity and Psychoticism, and responses in laboratory paradigms assessing cognitive and emotional processing. These differences raise the possibility of distinct mechanisms underlying psychopathy in African American as compared to European American prisoners.
• Correlates largely similar across countries: Our review of studies of adults (see Table 22.3) and youth (see Table 22.4) from different cultural and ethnic backgrounds provides evidence that the correlates of psychopathic traits are largely similar in different countries.
• Cross-cultural PCL-R means lower in Europe/Asia. Societal factors of collectivism may suppress overt traits.

Chapter 21. Psychopathy in Women: Assessment, Manifestations, and Etiology

Authors: Edelyn Verona and Jennifer Vitale

Female psychopathy manifests with relational aggression and internalizing comorbidity, assessed via PCL-R showing lower prevalence but similar structure. Etiological factors include trauma and hormonal influences, with neurocognitive deficits paralleling males but moderated by gender.

• Factor 2 is more emotionally disregulated: there is some evidence that psychopathy, at least the secondary subtype, is manifested in more emotionally dysregulated ways (e.g., BPD, suicidality) and within more intimate interpersonal contexts (e.g., domestic interactions, sexuality) among female compared to male offenders.
• More internalizing and self-directed harm: there is a growing body of work suggesting that psychopathic traits may not be protective for some types of internalizing problems, particularly suicidality and self-harm, in women compared to evidence for the protective role of these traits in men. In turn, these findings appear consistent with theorizing that impulsivity and aggression may be more likely manifested as self-directed violence and self-harm in women than in men (Forouzan & Cooke, 2005; Sadeh, Javdani, Finy, & Verona, 2011)
• Lower criminality and early conduct problems: less evidence of early behavior problems (Rutherford et al., 1998; Silverthorn & Frick, 1999), lower risk of criminal and violent recidivism (e.g., Edens et al., 2007),
• Manifestations: higher histrionic, borderline overlaps.
• Should we assess psychopathy differently for women? Assessment strategies may need to be modified for use with women. One approach may be to include other indicators of psychopathy that tap uniquely female expressions of antisocial–externalizing (Factor 2) tendencies, such as prostitution, sexual risk taking, IPV, self-directed aggression, and relational forms of aggression such as friendship betrayal and “backbiting.” It is unclear whether the use of alternative indicators will further improve the validity of psychopathy assessments with women, or instead blur boundaries between psychopathy and other personality disorders in women

Chapter 23. Deviance at Its Darkest: Serial Murder and Psychopathy

Authors: Eric W. Hickey, Bethany K. Walters, Laura E. Drislane, Isabella M. Palumbo, and Christopher J. Patrick

While psychopathy is a common characteristic among many serial murderers, the disorder is not solely defined by this crime, nor is it a necessary prerequisite for it. The association is driven less by the Disinhibition/Erratic Lifestyle factor and more by the core affective deficits (Meanness) that facilitate the violence.

• The Affective Core: Serial murder is predominantly linked to the Meanness (Affective) features of psychopathy, such as a lack of empathy and emotional coldness, which allow the perpetrator to commit heinous acts without remorse.
• Compartmentalization: many serial murderers can maintain an outwardly normal appearance (e.g., steady job, family life) while committing crimes in a highly secretive, compartmentalized manner, suggesting that high levels of Boldness and lower levels of Disinhibition may be present in some cases (e.g., John Gacy, Gary Ridgway).
• Mass murderers are different than serial murderers: Mass murderers are also far more likely than serial murderers to meet diagnostic criteria for severe mental disorders such as schizophrenia or bipolar disorder, whereas serial murderers more often exhibit personality disorders (most typically antisocial personality), along with paraphilias in many cases (Douglas, Burgess, Burgess, & Ressler, 2013; Duwe, 2004; Hickey, 2015; White-Hamon, 2000).
• Typical psychopath vs. typical serial murderers: we hypothesize that only a small proportion of serial murderers are “true psychopaths”—that is, individuals with an essential psychopathic disposition who engage in serial homicide. As conceptualized classically (Cleckley, 1976), psychopathy involves a persistent pattern of reckless, irresponsible behavior that pervades the affected individual’s life. By contrast, many serial murderers commit their crimes in a secretive, highly compartmentalized manner—maintaining an ostensibly normal pattern of behavior in other areas of life (e.g., residing in a permanent home, maintaining a steady job, being married and raising children).
• Fantasy-Driven Behavior: serial murder is predominantly a fantasy-driven pattern of behavior, which can arise in individuals with different interpersonal styles, confirming that the psychopathic profile is not universally identical among all serial killers.
• Most serial murderers are men: it’s not true that they’re ‘genius level IQ’ or particularly low-IQ and it’s not true they’re mostly white. But it’s true they’re mostly men
• Start older: In contrast with other homicidal offenders, serial murderers typically commence killing at older ages, beginning in their early 30s on average (Fox & Levin, 2015; Godwin, 2008; Hickey, 2015).

PCL-R Ratings for Five Well-Known Serial Murderers

The authors examined five notorious serial murderers based on interviews, avaible history, and court documents, and then compared the scores to each other and clarified when they were different.

Consistent with the idea of a systematic relationship between serial murder and psychopathy, all five of these perpetrators exhibited salient psychopathic symptoms. However, contrary to the view that most serial killers (including these specific ones; LaBrode, 2007) are clinically psychopathic, only one of the five (Ted Bundy) exceeded the PCL-R cutoff score of 30 out of 40 points required for a diagnosis of psychopathy (Hare, 2003).

The authors conclude that most serial killers do not meet the clinical 30-point threshold for psychopathy, suggesting that their crimes are often driven by specialized paraphilias or other mental disorders rather than a “core” psychopathic personality.

All credits to the authors: Hickey, Walters, Drislane, Palumbo, and J. Patrick

The authors state that the affective features of PCL-R psychopathy are most consistently present in serial murderers because of the very nature of the acts perpetrated by serial murderers, involving repeated fatal victimization of others:

In summary, the data presented in Table 23.1, together with our ratings of other serial murder cases to date, suggest that the main basis for a systematic association between the phenomenon of serial homicide and the diagnosis of psychopathy lies in the callous–unemotional (meanness) features represented in the Affective facet of the PCL-R. Two potential bases for this systematic association are that (1) deficient remorse, lack of empathy, and rationalization are part and parcel of serial homicide offending, and (2) lack of social connectedness (disaffiliation) contributes to serial murder, as well as to callous–unemotional features of psychopathy.

Chapter 24. Successful Psychopathy

Authors: Stephen D. Benning, Noah C. Venables, and Jason R. Hall

The “successful psychopath“, who manages to avoid negative outcomes at least and enjoy some levels of personal success, is distinguished from the “unsuccessful” variant by possessing higher levels of adaptive traits—primarily Boldness—which are hypothesized to confer greater cognitive ability and better emotional regulation.

• It’s an old concept: “Successful psychopathy” is a concept that has long captured the interest of researchers and clinicians alike (Smith, 1978; Widom, 1977). This seemingly paradoxical concept has its roots in Cleckley’s (1976) landmark monograph, The Mask of Sanity. Others have argued that certain psychopathic traits (e.g., glibness/charm, fearlessness) may serve as valuable personal assets in certain professions, including law, politics, business, or emergency responding (Babiak & Hare, 2006; Lykken, 1995).
• But it’s a difficult phenomenon to study: Despite long-standing interest in this topic, successful individuals with psychopathy have proven to be an elusive target for research. Efforts to systematically study high-functioning persons with psychopathy in the community have been impeded by methodological obstacles. In particular, identifying and recruiting individuals with high levels of psychopathic traits from the general population pose ongoing challenges given issues of definition (discussed below) and the low prevalence of individuals with extreme psychopathic tendencies in noninstitutional settings.
• Intact or even enhanced executive functioning are key (e.g., planning, decision-making) and greater autonomic reactivity to emotional stressors compared to their unsuccessful counterparts, allowing them to navigate complex social/professional environments effectively.
• Successful psychopaths’ brains are closer to healthy controls: in terms of prefrontal cortex gray matter (Yang et al., 2005), along with orbitofrontal cortex and amygdala volume (Yang, Raine, Colletti, Toga, & Narr, 2010), and in terms of symmetry between the left and right anterior hippocampus (Raine et al., 2004). Raine and colleagues (2004) have interpreted the relatively intact autonomic physiology and neuroanatomy of successful individuals as factors protecting such individuals from committing crimes in obvious or easily detectable ways.
• Strategic defection: psychopathic traits are associated with defection against coparticipants in the Prisoner’s Dilemma game (Rilling et al., 2007), particularly against people who are viewed as low in value (Gervais, Kline, Ludmer, George, & Manson, 2013). Indeed, Mealey (1995) proposed a sociobiological model of psychopathy that characterizes people with psychopathy as deceptive cheaters, whose proclivities for antisocial behavior are genetically determined.

Defining Success

The authors start with the lowest bar of success as avoiding the worst outcomes:

• Incarceration: Among adjudicated offenders, high and intermediate levels of psychopathy are associated with a higher proportion of crimes going undetected than low levels of psychopathy (Aharoni & Kiehl, 2013), suggesting that higher psychopathy is associated with more effective evasion of legal contact. However, in absolute terms, higher psychopathy tends to be associated with earlier and more extensive criminal arrests/convictions.
• Psychopathology: psychopathy, particularly its impulsive– antisocial features, is systematically associated with problems such as alcohol and drug dependence, as well as with rule breaking and aggression (Patrick, Hicks, Krueger, & Lang, 2005). Better-functioning, successful psychopathic individuals are expected to show fewer problems of these types: Rule breaking, to the extent it occurs, is less apt to lead to legal problems, and substance use is more likely to be recreational than habitual.

Then, they move to Attaining Desirable Outcomes:

• Agency: there are conceptual and empirical reasons for hypothesizing that psychopathic traits may contribute to success in areas involving goal-oriented activity (agency), like socioecological niches that favor the ruthless pursuit of status (ie., dense, transient populations that encourage individual-level approaches to resource (Kinner, 2003). Modern could be an occupational niche that rewards psychopathic behavior (Wexler, 2008)—in particular with large size, rapid growth, or frequent restructurings that foster instability in employee relations and insulate against the interpersonal consequences of selfishness (Babiak, 1995). Workers in professional settings are more likely to come into contact with individuals with psychopathic traits than are clerical or other junior workers (Boddy, Ladyshewsky, & Galvin, 2010), and high psychopathic tendencies are 3.5 times more common at senior levels compared to the general population (Babiak & Hare, 2006).
  • Heroism: Heroism is another form of societal success that shows some association with the interpersonal–affective features of psychopathy. This association shows up most clearly when these features are indexed separately from the disinhibitory features of psychopathy. Fearless Dominance as indexed by the PPI and related measures (cf. Drislane, Patrick, & Arsal, 2014) is associated with everyday heroism (Smith, Lilienfeld, Coffey, & Dabbs, 2013), in which people provide aid to others at the risk of minor physical danger to themselves. Fearless Dominance is also associated with engagement in occupations involving high levels of physical risk (Lilienfeld, Latzman, Watts, Smith, & Dutton, 2014)
  • Also read: Psychopaths & Machiavellians at the top (emotional intelligence lie)

• Communion: psychopathy is unrelated to deficits in theory of mind (i.e., ability to deduce the thoughts/motives of others), but negatively related to empathic concern for others (Blair, 2008; Mullins-Nelson, Salekin, & Leistico, 2006; Seara-Cardoso, Neumann, Roiser, McCrory, & Viding, 2012; Wai & Tiliopoulos, 2012). Psychopathic individuals are more likely to befriend others for instrumental than for affiliative reasons (Jonason & Schmitt, 2012), which may cause others to dislike interacting with such individuals in cooperative situations (Rauthmann, 2012).
  Communal success could mean having many (typically short-term) sexual partners (Hare, 2003; Jonason, Li, Webster, & Schmitt, 2009; Jonason, Valentine, Li, & Harbeson, 2011), though it’s not empirically established whether it results in more offspring (Gladden, Figueredo, & Jacobs, 2009; Glenn, Kurzban, & Raine, 2011).
  Finally, if successful in poaching others’ sexual partners, they also appear more vulnerable to having their own sexual partners poached (Jonason, Li, & Buss, 2010).

Success Must Be Assessed In All Life Areas, & Over Long-Term

I found it interesting that the authors picked Jordan Belfort as an example:

a person can achieve a high level of professional success and still be unsuccessful in life as a whole. For instance, Jordan Belfort (known as “the Wolf of Wall Street”; Belfort, 2007) (…) conviction for offenses related to these activities required him to pay $110 million in restitution to his victims.
This high-profile case highlights the fact that an individual with psychopathic traits who appears highly successful at one point in time may fail spectacularly at a later point and therefore no longer qualify as successful. Thus, the designation of an individual with psychopathic traits as successful should be considered provisional, subject to revision based on later biographical events.

In Belfort’s case though, he still ended up successful thanks to the fame that the movie brought him (which by the way lends credibility to moderated psychopathy model, in this case moderated by IQ/strategic predisposition).
The same can be said of some recent former mobsters who acquired a sizable following on social media (ie.: Michael Franzese and Salvatore ‘Sammy the Bull’ Gravano).

The 3 Models of Successful Psychopathy

Three main frameworks attempt to explain how some individuals high in psychopathic traits function adaptively in society, and they can be complementary:

1. Subclinical Psychopathy Model

The subclinical model proposes that successful psychopaths are simply milder versions of clinical psychopaths. The core traits are largely the same, but expressed at lower severity or without crossing the threshold into chronic criminality.

There is evidence for differences between the two, and also for differences between sub-clicanically high psychoapthy and non-psychopathy:

The relationship between psychopathic tendencies and performance on tasks indexing risk taking and aggression appears to differ in nonclinical as compared to offender samples.
(…)
In undergraduates, subclinical psychopathy is associated with real-world cheating on classroom exams (Nathanson, Paulhus, & Williams, 2006b), proclivities toward body modification and tattoos (Nathanson, Paulhus, & Williams, 2006a), and preferences for antisocial forms of entertainment (Williams, Paulhus, & Hare, 2007).
Psychopathy scores are higher on average for undergraduates who choose to study business as opposed to the arts or science (Wilson & McCarthy, 2011)
(…)
willingness to tolerate unethical practices mediates the relationship between psychopathy and publication rates for academic accountants (Bailey, 2015).

🔎 Example: The authors mention ‘The Godfather‘ Michael Corleone as an example of subclinical psychopathy.

However, research shows that individuals considered “successful” often display not just lower psychopathy, but different traits, including higher conscientiousness, planfulness, and goal-directedness. These traits not easily explained by mere attenuation of psychopathy. This suggests that success is not just “less psychopathy,” but rather psychopathic traits combined with compensatory adaptive characteristics (Lilienfeld et al., 2015a; Lilienfeld et al., 2016).

One more empirical finding that struck me at odds with this model is that the crucial executive functioning doesn’t seem to be much higher in subclinical psychopaths:

However, given that executive functioning, as measured by the Porteus Maze Test, is not enhanced in participants with subclinical psychopathy (Widom, 1977), the relationship between successful psychopathy and executive functioning may be limited to certain capacities (e.g., flexible responding as opposed to planning) or variable across samples.

In short, attenuation alone appears insufficient. Additional self-regulatory strengths are typically present.

2. Moderated Psychopathy Model

The moderated model argues that successful and unsuccessful psychopaths share largely similar core dispositions, but environmental and individual moderators shape life outcomes. Under this view, psychopathy is the same underlying liability, but its behavioral expression depends on buffering factors.

Proposed moderators have included intelligence, executive functioning, parenting quality, socioeconomic status, special talents, and physiological traits such as fear reactivity. Age is one of the more consistently supported moderators, given the well-established decline in antisocial behavior across adulthood.

Classic formulations, such as the fearlessness model, suggest that low fearfulness constitutes a core vulnerability that may lead either to antisocial outcomes under poor socialization or to adaptive high-risk roles under more favorable developmental conditions (Lykken, 1995).

Importantly, empirical support is uneven.

Intelligence shows weak and inconsistent moderating effects. <— 🙋🏼‍♂️ Lucio’s note: However, chapter 25 suggests otherwise, at least when it comes to violence. In a passage, the authors’s state that ‘subsequent studies have failed to detect a significant interaction between psychopathy and intelligence in predicting legal contacts, incarceration, or recidivism (Holland, Beckett, & Levi, 1981; Walsh, Swogger, & Kosson, 2004; Watts et
al., 2016). But when I checked Watts’ study, it suggested the opposite, saying ‘we found some support for the hypothesis that intelligence served as a protective factor against antisocial behavior among individuals with high levels of psychopathy’

Parenting effects, while present, are stronger for factor than factor 1.
As for SES, the few existing studies show it does not affect the development of conduct problems in youth with callous–unemotional traits (Barker, Oliver, Viding, Salekin, & Maughan, 2011), nor does it affect recidivism in individuals with psychopathic traits (Walsh & Kosson, 2007).

But executive functioning seems to matter a lot:

Because executive function by itself does not appear to be associated with psychopathy (Dolan, 2012; Mol, Van Den Bos, Derks, & Egger, 2009), it may be a more promising moderator of success in psychopathy than intelligence.
Indeed, unlike individuals who exhibit high levels of antisocial behavior (Morgan & Lilienfeld, 592 2000), successful individuals with psychopathy have superior executive functioning compared to controls, and unsuccessful individuals with psychopathy, as assessed by perseverative errors on the Wisconsin Card Sorting Test (Ishikawa et al., 2001; cf. Valliant, Freeston, Pottier, & Kosmyna, 2003).

3. Multiprocess (Dual-Process / Triarchic) Model

The most mechanistically precise account comes from multiprocess perspectives, which argue that psychopathy is not unitary but reflects partially independent dispositional systems.

Dual-process theory distinguishes between:

• a defensive fear system deficit underlying interpersonal–affective traits, and
• an executive control deficit underlying impulsive–antisocial traits.

Weak defensive (fear) reactivity contributes most directly to the interpersonal–affective features of psychopathy, including charm and manipulativeness, grandiosity, and emotional insensitivity with low empathy and nonanxiousness,

From the standpoint of the two-process model, successful psychopathy can be seen as the product of a low fear disposition unaccompanied by significant cognitive–executive dysfunction. Such individuals would be expected to be highly self-confident, socially assertive, and persuasive, and lacking in sensitivity to the feelings of others due to reduced personal experiences of fear, anxiousness, and distress. Consistent with these suppositions, those high in fearless dominance are more likely to make selfishly profitable decisions in economic games (Yamagishi, Li, Takagishi, Matsumoto, & Kiyonari, 2014); they also have higher incomes (Benning, Patrick, Hicks, Blonigen, & Krueger, 2003) and ranks in financial occupations (Howe, Falkenbach, & Massey, 2014).

Conversely, unsuccessful psychopathy lacks executive control:

From a two-process perspective, unsuccessful psychopathy (i.e., expressed as persistent criminal deviance leading to repeated convictions and periods of imprisonment) can be viewed as arising from salient cognitive–executive dysfunction (cf. Moffitt, 1993) and antisocial attitudes alloyed with low dispositional fear. Unsuccessful psychopathy is further likely if an individual experiences adverse events that engender social detachment, distrust, and hostility or even hatred toward others (Christian, Meltzer, Thede, & Kosson, 2017; Lynam, 1996; Patrick et al., 2009).

These two processes are theorized to underpin the two main psychopathy factors, and research has provided compelling support for this theoretical model, especially with the PPI factors that display stronger diverging associations (for reviews, see Patrick, 2007; Patrick & Bernat, 2009; Skeem, Polaschek, Patrick, & Lilienfeld, 2011).

The triarchic model formalizes this further by separating boldness, meanness, and disinhibition as partially independent trait domains (Patrick et al., 2009). Within this framework, boldness reflects adaptive tendencies, along with some aspects of maladaptive functioning (Skeem et al., 2011).
Boldness seems to generally adaptive, and especially so for certain niches:

In the domain of work and business leadership, ratings of supervisors’ boldness are positively associated with subordinates’ satisfaction with supervisors and with their jobs; by contrast, meanness and disinhibition are negatively related to these variables (Sanecka, 2013). High levels of boldness have also been found in special military teams assigned to patrol remote regions of Greenland (Kjærgaard, Leon, Venables, & Fink, 2013) and to North Pole expeditions (Leon & Venables, 2015). These studies highlight the potential contribution of high boldness (or dispositional fearlessness) to success in the business world and to effective performance in extreme environments.

But Boldness + Meanness/Dishibition Is Problematic & Meanness + Dishibition is Worst

Individuals high in meanness and boldness can be expected to express their social and emotional poise in exploitative–antagonistic ways, while boldness and disinhibition, could be similar Cleckley’s conception of psychopathy as a “masked” pathology: seemingly emotionally well adjusted and socially adept but act out in reckless, irresponsible ways to gratify immediate desires, without regard for adverse consequences.

Disinhibition coupled with high meanness would be expected to manifest as severely aggressive externalizing behavior, ranging from psychological pressure or physical force to achieve selfish goals to sadistic acts of violence.

This structure provides the clearest modern explanation of “successful psychopathy”: individuals high in boldness but relatively low in disinhibition are less likely to show chronic antisocial failure.

The authors’ examples are Don Draper, Sonny from The Godfather, and Amy from Gone Girl.

🙋‍♂️Lucio’s 4th model: Exchange Theory of Successful Psychopathy (Buffalmano, 2026)

Lucio:
The Exchange Theory of successful psychopathy builds upon the Moderated Model, narrowing its focus on ‘social and mate value‘ moderating traits, and linking it to the social exchange as a legal and socially-approved venue for selfish goal-achievement.

For example, an attractive, high-IQ, power-aware, strategically inclined and confident (potentially from narcissistic grandiosity) psychopathic individual can exchange his value and previously acquired resources to get what he wants, without having to resort to higher risk, win-lose coercion. Or, at least, he can ‘limit himself’ to more grey-area but rarely sanctioned forms of pressure tactics.
This doesn’t make him any nicer, so it doesn’t need to be ‘less of a psychopath’, as he can cooperate smartly and calculatively while being ruthlessly unempathic, but it makes him less likely to fall on the wrong side of the law.

An example may be Ashton Kutcher’s character in the movie Spread, who lives off women’s largesse thanks to his attractiveness, Machiavellianism, and seduction skills.

Basically, this says that high-fitness psychopaths succeed because they can use the exchange game over the predatory game, and gain even larger returns with lower risks. For certain traits such as attractiveness, this may be obvious, even if only subconsciously, also to lower IQ individuals.

This model probably works best in combination with the multiprocess theory, for individuals with intact executive control, and is probably correlated with Machiavellianism.
That said, more ‘readily monetizable traits’ like looks, and especially for women, may lower the bar to the exchange game, even in the presence of higher disinhibition (ie.: exchange goods for sexual favors or companionship).

🙋‍♂️Lucio’s 5th model: Calibration Theory of Successful Psychopathy (Buffalmano, 2026)

Lucio:
This model suggests that success is determined by the ability to contextually regulate psychopathic expressions.

The ‘calibrated’ psychopath uses strategic compartmentalization. He may apply ‘Meanness’ and ‘Boldness’ as tools in competitive environments, while switching to a simulated, functional, or even genuine ‘pro-social’ mode in cooperative environments (family/alliances) to protect his long-term interests and social support.

For example, they may be more ruthless at work, and be able to ‘switch off’ outside of it to improve intimate relationships and friendships.

As anecdotal example, even during tough divorce proceedings with first-wife Ivana, Trump once said he’d ‘never say anything bad about his wife because ‘she’s the mother of my children’. That preserved functional relationships with the ex-wife and his children, improving family ties and reputation.
But in another interview about his work approach, prodded about a vicious reputation, he asked if that was a compliment.
And while we may know little of Trump’s intimate relationships behind doors, that may at least signal the intention of two different modes.

Researcher Keith Campbell proposed something similar for the related trait of narcissism when he advised ‘use it publicly, not privately’ (Campbell, 2020).

Empirical Conclusions

Successful psychopathy is best understood not as a single coherent subtype, but as particular configurations of partially independent liabilities. Individuals combining fearlessness and social dominance with intact executive control are far less likely to follow the chronic antisocial pathway.

Whether termed “fearless dominance,” “boldness,” or “weak defensive reactivity,” dispositional fearlessness in itself appears to be associated with a range of adaptive tendencies, as well as with certain deviant tendencies readily recognizable as psychopathic (e.g., narcissism, risk taking). As such, the presence of dispositional fearlessness in the absence of neurocognitive liability for externalizing problems is perhaps the clearest basis for successful psychopathy. Other combinations of bold, mean–callous, and disinhibitory tendencies may also be associated with successful, noncriminal outcomes—but further systematic research is needed to evaluate the ways in which these differing configurations of psychopathic attributes are expressed.

Disinhibition—closely aligned with the externalizing spectrum—appears to be the primary driver of persistent antisocial behavior and life dysfunction (Patrick et al., 2005; Skeem et al., 2011).

Finally, empirical research also points to several aspects that increase the odds of successful psychopathy including increased age, higher executive functioning, and physiological and neuroanatomical similarity to healthy controls as traits.

🙋‍♂️Lucio’s Take: Super useful chapter 🙏🏼

Lucio:
From an applied perspective, this was one of the most insightful chapters.
I want to thank the authors first and foremost.

If I may offer one small suggestion: it could help to add a few more sentences clarifying how the field moved from the dual-process theory to the triarchic model. The connection may be obvious to researchers, and I was able to infer it and explore it further myself, but a bit more context—whether chronological or conceptual—could make the bridge clearer for non-research readers.

Learn more:

• Effective psychopathy, TPM’s take on ‘successful psychopathy’

PART VI CLINICAL AND APPLIED ISSUES IN PSYCHOPATHY

Chapter 25. Psychopathy and Aggression

Authors: Stephen Porter, Michael T. Woodworth, and Pamela J. Black

CONCLUSION: Available research findings indicate a clear relationship between psychopathy and aggressive behavior. In fact, the case can be made that high-psychopathic individuals commit more nonsanctioned violence than any other members of society.

• Proactive Aggression: This form of aggression is selectively related to the Meanness (Callous-Unemotional) component of psychopathy, reflecting a lack of empathy and a willingness to exploit others.
• Reactive Aggression: While psychopathic individuals engage in reactive aggression, it is less central to the construct and is more strongly correlated with the Disinhibition and high-anxiety/secondary psychopathy subtypes.
• Often it’s a mix of reactive and proactive: some violent acts contain elements of both reactivity and instrumentality (Bushman & Anderson, 2001). For example, Barratt, Stanford, Dowdy, Liebman, and Kent (1999) found that only 20–25% of the aggressive acts coded in their sample could be classified as either strictly premeditated or impulsive. Therefore, researchers who study aggressive behavior must refine their operational definitions beyond simply “instrumental” or “reactive” in order to capture the complexities of motivations for violence.
• Factor 1 more premeditated, factor 2 more reactive: There is evidence that scores on Factor 1 of PCL-R psychopathy, reflecting emotional coldness and manipulativeness, are related to premeditated, unprovoked, instrumental aggression (Reidy, Zeichner, Miller, & Martinez, 2007; Reidy, Zeichner, & Seibert, 2011), whereas scores on Factor 2, reflecting impulsive–irresponsible tendencies and antisocial behaviors, are more highly correlated with reactive violence (Falkenbach, Poythress, & Creevy, 2008; Hecht, Berg, Lilienfeld, & Latzman, 2016; Reidy et al., 2007; Reidy, Zeichner, & Martinez, 2008).
  • Same for sub-facets: Furthermore, at the facet level, PCL-R Facets 1 and 2 have been related to premeditated aggression, and Facets 3 and 4 to impulsive aggression (Declercq, Willemsen, Audenaert, & Verhaeghe, 2012; Flight & Forth, 2007; Snowden & Gray, 2011; Walsh, Swogger, & Kosson, 2009). These findings are in line with the previously noted results indicating that instrumental violence is related to little, if any, emotional arousal during acts of aggression
  • But factor 1 manipulates to appear more reactive: . analyses from Porter and Woodworth (2007) revealed that the tendency to exaggerate the reactive quality of homicide offenses was strongly related to PCL- R Factor 1 scores, and unrelated to Factor 2 scores.
• Dishibition related to severe aggression: Marcus and Norris (2014) evaluated relations between subscales of the TriPM and sexual coercion using a vignette paradigm. They found that scores on all three TriPM scales (Boldness, Meanness, Disinhibition) predicted reported use of low-level sexually predatory tactics, and that Disinhibition was uniquely predictive of use of severe, potentially criminal coercive tactics.
• As a whole, psychopathy may protect against reactive aggression: the relationship between psychopathy and reactive violence is not as clear. It appears that total scores and Factor 2/SCI scores are often related to impulsive aggression, but to a lesser degree than Factor 1 scores correlate with instrumental aggression in an in-depth review of research on the relationship between psychopathy and reactive violence, Reidy, Shelley-Tremblay, and Lilienfeld (2011) concluded that existing evidence as a whole points to psychopathy as a protective factor against impulsive violence.
• Factor 2 more linked to criminal behavior, factor 1 to motivation: would appear that while Factor 2 behavioral features may have a more direct and obvious relationship with criminal offending and recidivism (e.g., Walters, 2003), the core emotional–interpersonal traits of psychopathy represented in Factor 1 may better help to explain the motivations that underlie the serious types of violent crimes that psychopathic offenders choose to commit (see also Skeem, Poythress, Edens, Lilienfeld, 2011)
• Psychopaths may enjoy aggression: recent research indicates that psychopathic offenders may derive gratification or enjoyment from their violent behavior. Analyses of their sexual violence, in particular, suggest that both thrill- seeking and sadistic interests may play an important role in psychopathic crime. (🙋🏼‍♂️ Lucio’s note: I wasn’t sure how thrill-seeking may have been at the same level of sadism alone or high meanness rather than being, for example, just a smaller added contributor)
• Self-harm is mainly related to factor 2: existing research at this time suggests that self-harm is related mainly to impulsive–antisocial (Factor 2) features of psychopathy, as assessed by different inventories, it may be the case that offenders who exemplify the affective–interpersonal features of psychopathy engage in self-harmful behavior that is insincere and enacted to manipulate others
• Assessment in Different Populations: The chapter reviews the manifestation of psychopathy-related aggression across various populations, including incarcerated adults and children with Conduct Problems.

Intelligence moderates violent expressions of psychopathy

The theory sounds logical:

A potential moderator of the relationship between psychopathy and violence is intelligence; that is, more intelligent psychopathic individuals may be less inclined to act aggressively because they can use their cognitive resources to devise nonviolent means (e.g., conning and manipulation) to get what they want (Nijman, Merckelbach, & Cima, 2009; Vitacco, Neumann, & Wodushek, 2008).
Less intelligent psychopathic individuals may resort to violence to compensate for their inferior abilities to manipulate others through language.

And the evidence seems to support it:

As evidence for this, Heilbrun (1982) found that past violent offending in a sample of male prisoners was influenced by the interaction of intellectual level and self-reported psychopathic tendencies: Less intelligent offenders who scored high in psychopathy showed greater likelihood of having a history of impulsive violence than either more intelligent psychopathic offenders or less intelligent nonpsychopathic offenders.
In line with this, Heilbrun and Heilbrun (1985) reported that the most dangerous individuals in a sample of offenders were those with the following characteristics: psychopathic, low IQ, socially withdrawn, and history of violence.

🙋🏼‍♂️ Lucio’s note: However, chapter 24, although more related to criminality rather than simply violence, seems to suggest otherwise

However, a confounding variable is that IQ may better allow individuals to avoid conviction, rather than outright engaging in less aggression or violent behavior:

Ishikawa and colleagues (2001) tested a community sample of 16 “unsuccessful” and 13 “successful” psychopaths (classified based on their PCL-R scores and whether they had incurred criminal convictions) on laboratory measures of autonomic stress reactivity and executive functioning (referring to the capacity for initiation, planning, abstraction, and decision making). Although differing in conviction history, the two groups had engaged in substantial and similar amounts of self-reported criminal behavior, including violent acts. Results from the laboratory assessment indicated that participants in the successful psychopathy group exhibited greater autonomic reactivity to emotional stressors and stronger executive functioning than those in the unsuccessful psychopathy group. The implication is that psychopathic individuals who are able to avoid apprehension and adjudication for their violent acts are those who possess intact capacities for planning and decision making.

Language patterns: past tenses, filler words, cause-effect subordinating conjunctions, & material goods

Hancock, Woodworth, and Porter (2013) used automated language analysis methods to explore the descriptions of homicides provided by these offenders (…) it was posited that many aspects of language use operate below the level of conscious control (…)
Two systems, Linguistic Inquiry and Word Count (LIWC; Pennebaker, Booth, & Francis, 2011) and Wmatrix (Rayson, 2008), were used to code transcripts (…)
high PCL-R offenders used more past-tense and fewer present-tense words in their narratives, as well more disfluencies (e.g., “uh” or “um”) than low PCL-R offenders, suggesting both psychological distancing and an emotional detachment from their crimes. Furthermore, high-psychopathy offenders used more subordinating conjunctions (indicative of cause-and- effect thinking) such as “because,” “since,” and “so that,” demonstrating that they provided more reasoning for their actions, consistent with greater instrumental motives. Tellingly, high psychopathic participants also were more likely to use language (even within the context of a murder narrative) reflective of material needs and gains, such as references to food, drink, and money.

Premeditation & instrumental vs. foolhardy: flawed predators

Clinical and empirical observations suggest that some physically aggressive actions by high psychopathic individuals share these characteristics of premeditation and instrumentality (….) However, most of these psychopathic individuals have difficulty controlling themselves at times (…) in ways that contribute to detection, arrest, and incarceration (…) In this light, individuals of this sort can be seen as “flawed predators,” frequently preying on others but unable to reliably control their behavior.

Psychopathy is linked with sexual deviancy and sadism

Sadism and psychopathy are different but correlated:

Mokros and colleagues (2011) evaluated whether psychopathy as indexed by items of the PCL-R and sadism as indexed by diagnostic criteria from DSM-IV-TR (APA, 2000) and the 10th edition of the International Classification of Diseases (ICD-10; World Health Organization, 2004) share a sufficient number of defining features that they can be considered the same construct. Based on analyses of data for a sample of 100 male sex offenders (50% of whom were considered sadistic), they concluded that psychopathy and sadism are distinct constructs, and that specific features of PCL-R psychopathy, such as the deficient affect (Facet 2) features, are actually predictive of sadistic behavior.

Psychopathic offenders had higher sadism scores:

Holt and colleagues (1999) found that such traits were more common among violent psychopathic offenders than violent nonpsychopathic offenders in a maximum security prison. Violent and sexually violent offenders did not differ in their level of sadistic personality traits, leading the authors to argue that the traits were not tied specifically to sexual pleasure.
(…)
Consistent with this, Woodworth, Freimuth, and colleagues (2013) reported that participants from a large sample of high-risk sexual offenders who showed elevated PCL-R psychopathy scores were significantly more likely to have a sadistic paraphilia than participants who exhibited either low or moderate psychopathy scores.

Sadism was associated with facets 1 and 4 of the PCL-R:

Robertson and Knight (2014) examined the relationship between general measures of sadism and psychopathy at the facet level, and found that a variety of measures of sadism (e.g., self-report scales, file review of past crimes) correlated with total scores on the PCL-R and scores on Facets 1 and 4.

Psychopathy is also associated with deviant sexual arousal:

studies have found higher PCL-R scores to be associated with sexual arousal in response to deviant visual and auditory stimuli. Specifically, available data indicate a significant but modest correlation (.21-.28) between PCL-R total scores and deviant sexual arousal (Barbaree, Seto, Serin, Amos, & Preston, 1994; Knight, 2010; Quinsey et al., 1995; Serin, Malcolm, Khanna, & Barbaree, 1994).

And empirical evidence from actual homicides support this, as analyzed by Porter and colleagues (2003)

homicides committed by psychopathic offenders (n = 18) showed significantly higher level of both gratuitous and sadistic violence than those committed by nonpsychopathic offenders (n = 20). Most psychopathic offenders (82.4%) had committed sadistic acts against their victims, compared to 52.6% of the nonpsychopathic offenders.

Somewhat related, Porter, Bhanwer, Woodworth, and Black (2013) found that psychopaths also have higher levels of schadenfreude:

Results indicated that higher psychopathy scores (as measured by Paulhus, Neumann, Hare, Williams, & Hemphill’s [2016] Self-Report Psychopathy Scale) were related to increased self-reported schadenfreude across all conditions, even after being primed to feel empathy.

Chapter 26. Psychopathy and Substance Use Disorders

Authors: Jarrod M. Ellingson, Andrew K. Littlefield, Alvaro Vergés, and Kenneth J. Sher

There is a significant and complex overlap between psychopathy and Substance Use Disorders (SUDs), driven primarily by shared vulnerability factors related to poor self-control and high sensation-seeking. The relationship is strongest for the Disinhibition facet of psychopathy (e.g., impulsivity, irresponsibility).

Most studies to date have found significant associations between psychopathy scores and measures of substance use and SUDs in a wide range of samples, including criminal, community, and clinical samples across development stages (adolescents and adults). Regarding subdimensions of psychopathy, there seems to be a robust association between the impulsive–antisocial factor and substance involvement, but less consistent or null associations for the affective–interpersonal factor. In studies employing the lower-level facets, associations are somewhat less robust, with the impulsive lifestyle and antisocial facets showing larger associations than the affective or interpersonal facets.

• Shared Etiology: Both psychopathy and SUDs are related to a broad underlying construct of Behavioral Disinhibition and externalizing proneness.
  • Disinhibition: facets of psychopathy within differing inventories that relate most closely to disinhibitory psychopathology—namely, those reflecting impulsive nonplanfulness and reckless irresponsibility—have demonstrated particularly strong associations with SUDs.
  • Externalizing proneness: Recent theoretical and factor-analytic work has suggested that a dispositional factor of externalizing proneness, reflecting shared variance among different forms of disinhibitory psychopathology, contributes to both psychopathy and SUDs.
• Dishinibitory liability as the root? Theoretical work across disciplines has suggested that a dispositional factor, sometimes labeled “disinhibitory liability” (Vanyukov et al., 2012), entails general deficits in inhibitory control and proclivities toward social deviance (e.g., rule breaking), and confers risk for all externalizing disorders, including psychopathy and SUDs (e.g., Gorenstein & Newman, 1980; Iacono, Carlson, Taylor, Elkins, & McGue, 1999; Sher & Trull, 1994; Yancey, Venables, Hicks, & Patrick, 2013).
• Heritable ‘behavioral under-control’ as another measure for disinhibition: Krueger and colleagues (2002) demonstrated that reverse-scored constraint (i.e., a broad-based measure of disinhibition assessed via the Multidimensional Personality Questionnaire; Tellegen, 1982; Tellegen & Waller, 2008) loaded on a general, highly heritable externalizing factor that also included measures of substance use and ASPD. This observation led to the conclusion that “personality and psychopathology are linked at an etiological level” (Krueger et al., 2002, p. 421). Consistent with this notion, evidence from the behavioral genetic literature suggests that the vast majority of the genetic correlation between alcohol dependence and conduct disorders is accounted for by variance in behavioral undercontrol, a broad- band measure of impulsivity (Slutske et al., 2002).
• SUDs are most associated with ASPD: The Epidemiologic Catchment Area study, which assessed DSM-III disorders, found that 83.6% of participants diagnosed with ASPD had a co-occurring lifetime SUD (Regier et al., 1990). In addition, rates of ASPD among participants diagnosed with lifetime SUDs ranged from 14.3% (alcohol) to 42.7% (cocaine).
  • Impulsive-antisocial factor explains most of psychopathy’s association with SUDs: The most consistent finding has been a significant association of total psychopathy scores with SUDs that is entirely explained by the impulsive–antisocial factor (Blackburn & Coid, 1998; Blackburn, Logan, Donnelly, & Renwick, 2003; Hart, Forth, & Hare, 1991; Hemphill, Hart, & Hare, 1994; Reardon et al., 2002; Smith & Newman, 1990).
  • Impulsive lifestyle stronger association: Walsh and colleagues (2007) found a strong and robust association for PCL-R Factor 2 with substance dependence. However, the impulsive lifestyle facet of Factor 2 demonstrated stronger associations than the antisocial facet with lifetime symptoms of alcohol and illicit drug dependence in this male sample, and with substance use among female offenders in another study (Kennealy et al., 2007).
• Psychopathy and SUDs share common genetic & biology: converging evidence suggests that both are associated with common neural systems (e.g., PFC, ACC), biomarkers (e.g., P300, ERN), and genetic markers (e.g., MAOA, COMT, ANNK1, 5-HTT, CHMR2).
• Factor 1 less related: Regarding facets of Factor 1, the interpersonal facet was positively correlated with cocaine, but not other drug, dependence symptoms (Walsh et al., 2007). Furthermore, adjusting for the other PCL-R facets resulted in negative correlations between the affective facet and some (though not all) substance use measures in both studies (Kennealy et al., 2007; Walsh et al., 2007), consistent with negative association of this facet with participation in substance use treatment (Durbeej, Palmstierna, Berman, Kristiansson, & Gumpert, 2014).
• Peaks at 18-25YO and decreases later: Although some have highlighted the temporal stability of psychopathy, ASPD, and related personality constructs (e.g., Lynam & Gudonis, 2005), others have noted the sharp decline in antisocial behaviors as individuals transition from adolescence to adulthood (e.g., Blonigen, 2010). This so-called “age-crime curve” (Hirschi & Gottfredson, 1983) parallels the “maturing out” of substance-related pathology (Winick, 1962), which “appears to be primarily a disorder of late adolescence and young adulthood” (Sher & Gotham, 1999, p. 933). Thus, engagement in antisocial behaviors and addictive behaviors both appear to rise and fall during emerging adulthood (roughly ages 18–25; Arnett, 2000).
  • Decrease in novelty-seeking and increasing in reward-seeking: Blonigen, Littlefield, and colleagues (2010) demonstrated that, relative to individuals who persisted in antisocial behaviors, those who desisted from antisocial behaviors across ages 18–25 showed marked decreases in novelty seeking (a trait broadly related to impulsivity–behavioral undercontrol) and larger increases in reward dependence (a construct related to positive emotionality and negatively related to disinhibition).
• Boldness: Also contributes through sensation-seeking—a willingness to take risks and pursue novel, exciting experiences (including drug use).

Chapter 27. The Role of Psychopathy in Sexual Coercion against Women

Authors: Raymond A. Knight and Jean-Pierre Guay

Psychopathy is a robust predictor of sexual aggression and coercion, a relationship primarily driven by the affective and interpersonal features of the disorder. The lack of empathy and callous exploitation of others (Meanness) allows for the instrumental use of sexual violence without guilt, which is the defining characteristic of this link.

• Rape is part of a general propensity towards antisociality and not ‘specialized’: These findings replicated prior research suggesting that the commission of rape can be characterized as part of a broader general propensity to act in an antisocial manner (Lussier, LeBlanc, & Proulx, 2005; Smallbone, Wheaton, & Hourigan, 2003). Likewise, the versatility of offense behavior found among rapists in these studies is consistent with the hypothesis that antisocial tendencies are pervasive among convicted rapists.
  • Only child molesters ‘specialize’: Examining the criminal records of 506 sex offenders being evaluated for sexual commitment, Harris, Smallbone, Dennison, and Knight (2009) found that sex offenders as a whole were versatile (criminal generalists), regardless of whether they were committed or determined not to be sexually dangerous and released back to prison to complete their sentences. Indeed, evidence for specialization was found only in the child molester subgroup.
• Sadism is part of psychopathic coercion: both the iterative, empirically driven revisions of the MTC rape typologies (Knight, 2010) and the generation of a SEM for the etiology of sexually coercive behavior against women (Knight & Sims- Knight, 2016) have yielded evidence across multiple samples for a covariation between facets of psychopathy and sadism in both archival ratings and self-report measures.
  (…) the combined CM/Hypersexual trait showed substantial covariation with Sadistic fantasies (Knight, 2013; Sims-Knight, 2013).
  • Paraphilia and sadistic fantasies also linked: recent studies that have examined the relation for psychopathy as a whole have continued to show evidence of covariation between total psychopathy scores and sadistic fantasies and paraphilias (e.g., Fischer, 2008; Hill, Habermann, Berner, & Briken, 2006; Woodworth et al., 2013).
• Sadism may be the ‘upper end’ of agonistic continuum: support for a reconceptualization of sadism as the extreme high pole of an agonistic continuum that extends from no sexually coercive fantasies or behaviors at the low end, through paraphilic coercive fantasies, to fantasies of controlling, bondage, and humiliation during sex, to fantasies of hurting a victim during sex, and finally to serious sadistic fantasies and behaviors (Knight, 2010; Knight, Sims-Knight, & Guay, 2013; Mokros, Schilling, Weiss, Nitschke, & Eher, 2014). The current exploration of only the extreme upper end of this continuum might mask important relations because of partial measurement and truncation of the full range of the construct. Indeed, some data suggest that different subdimensions of psychopathy may be differentially related to varying levels of the agonistic continuum (e.g., Liu, 2014; Sims-Knight, & Guay, 2011).

Three lines of research highlight the link between psychopathy and

Three independent research-domains highlight that key symptomatic subdimensions of psychopathy play significant roles in rape:

First, in the general criminal research literature, there were some indications of increased risk for sexual coercion among psychopathic criminals, and this risk was consistent with recent theoretical explanations of particular symptom subdimensions of psychopathy.
Second, studies of incarcerated rapists revealed a high incidence of psychopathy, and the facets of psychopathy had emerged as critical elements in an empirically validated typological model that identified important individual differences among rapists. Moreover, psychopathy had been identified as an important predictor of sexual recidivism among convicted rapists.
Third, in both offender and nonoffender samples, the symptomatic facets of psychopathy had been identified as traits that define critical paths in structural equation models of the etiology of sexual aggression against women.

Sexual coercion may be linked to short-term sexual strategies:

evolutionary explanations for sexual coercion have also highlighted the importance of psychopathic tendencies. Most notably, it has been speculated that proclivities toward short-term relationships, high mating effort, and low parental investment on the part of psychopathic individuals (Quinsey & Lalumière, 1995), along with their use of short-term cheating strategies (Mealey, 1995), might coalesce into a high reproduction-rate (r-selection; Pianka, 1970) mating strategy that not only has some evolutionary advantages but also increases the probability of sexual aggression. Although the evidence for such theories remains tentative (Marcus, Sanford, Edens, Knight, & Walters, 2011), recent neurobiological research nonetheless supports the hypothesis that dysfunctions in brain regions that are key to emotional processing and morality judgments may allow psychopathic individuals to pursue this evolutionary strategy (Glenn & Raine, 2009). Moreover, such evolutionary speculation emphasizes the theoretical congruence between characteristics associated with psychopathy and those associated with rape.

Read more:

• Investigative case study of psychopaths’ sexual strategy

The 3-path model to coercion

Knight and colleagues’ improved Malamuth’s original two-path Confluence Model (1991) with:

1. Callous–Manipulative latent trait (replacing hypermasculinity, it’s a latent trait not from PPI/PCL-R, but from MIDSA and related to factor 1)
2. Antisocial latent trait pathway (added)
3. Hypersexuality (maintained)

This three-path model (callous-manipulative traits, antisocial tendencies, and hypersexuality) significantly improved predictive power and was replicated across criminal and noncriminal samples, adolescent and adult samples (Knight & Sims-Knight, 2003, 2004, 2011, 2016).

Independent laboratories have similarly found that psychopathy dimensions—particularly callousness, manipulation, impulsivity, and antagonism—covary with impersonal sex attitudes, sexual dominance, unrestricted sociosexuality, and higher sexual drive (Harris et al., 2007; Visser et al., 2010; Kastner & Sellbom, 2012; LeBreton et al., 2013; Jonason et al., 2009; Baughman et al., 2014; Carter et al., 2014), and there is a strong covariation between Callous–Manipulative (CM) traits and Hypersexuality (Johnson & Knight, 1998; Knight & Sims-Knight, 1999; Graham & Knight, 2017). Combining the two improves model fit (Knight, 2013).

Conceptually, the unifying thread between CM traits and hypersexuality appears to be a primary reward focus and disregard for secondary information—others’ needs, long-term consequences, or social norms. This aligns with Newman’s response modulation hypothesis (Newman & Baskin-Sommers, 2011), which posits an attentional deficit in psychopathy: once goal-focused, individuals fail to process peripheral inhibitory cues. This mechanism is distinct from general executive dysfunction associated with antisocial behavior.

Neurobiological evidence supports this linkage. High self-centered impulsive psychopathy (PPI-Scl) predicts heightened mesolimbic dopamine recruitment in response to rewards (Buckholtz et al., 2010; Bjork et al., 2012). Brain regions implicated in reward processing (ventral striatum, anterior cingulate cortex) overlap with circuitry involved in sexual motivation (Stoléru et al., 2012). Structural and functional abnormalities in these regions are also documented in psychopathy (Kiehl et al., 2001; Birbaumer et al., 2005; Glenn & Raine, 2009). This suggests shared neurocircuitry underlying CM traits and hypersexual motivation.

The data aligns with reward-driven, sensation-seeking impulsivity (linked to CM and hypersexuality; instrumental aggression; reduced threat sensitivity) rather than affectively dysregulated and impulsive antisocial aggression (linked to antisocial behavior, negative emotionality, and reactive aggression.

🙋🏼‍♂️ Lucio’s note: I wished for more of the source studies linking psychopathy to hypersexuality to be published. Some of them were papers presented at various conferences or unpublished manuscripts.

All 3 dark triads are related to sexual drive, and psychopathy is the highest

Several studies have linked various measures of the Dark Triad traits (subclinical narcissism, Machiavellianism, and psychopathy; Paulhus & Williams, 2002) with a variety of measures of sexual behavior and fantasy. In a study of undergraduate students Jonason, Li, Webster, and Schmitt (2009) showed that the scores on the Dark Triad traits were positively related to having more sex partners, unrestricted sociosexuality, and a greater preference for short-term mates. In another study of college students, Baughman, Jonason, Veselka, and Vernon (2014) found that all three Dark Triad scales were related to sexual drive, with psychopathy showing the strongest relation. Testing an online sample recruited by a marketing company, Carter, Campbell, and Muncer (2014) found that scores on the Dark Triad correlated positively with both recreational sexual behavior and sexual desire for others for both males and females.

Different paths to impulsivity

There seem to be two different kinds of impulsivity:

1. Reward-driven ignoring secondary information when pursuing goals: It involves risk-taking, sensation-seeking, and focusing on getting what you want while ignoring consequences or other people’s feelings.
2. Emotion-driven: It involves being sensitive to threats, getting overwhelmed by negative emotions, and losing control when upset.

The research suggests that hypersexuality and callous–manipulative/self-centered impulsive traits are linked more to the first type — the reward-driven, goal-focused impulsivity.

The authors argue that it’s important to keep these two types separate, because they may explain different kinds of aggression. Psychopathy-related aggression may be more about the reward-driven, goal-focused type, while other aggression may be more about emotional dyscontrol.

They also criticize the triarchic model for mixing different kinds of impulsivity together under “disinhibition,” and for separating manipulative traits into a different category. In their view, that blending hides important differences instead of clarifying them.

🙋‍♂️Lucio’s Take: Interesting, I wished for more details on how they related to factors 1 and 2

Lucio:
The two paths the authors suggest about impulsivity seem to relate to factor 1 and factor 2.

But then they say that both hypersexuality and Callous Manipulative (CM), more linked with factor 1, and Self-Centered Impulsivity (ScI), more linked with factor 2, appear to both covary both with the reward-driven impulsivity, while based on the previous chapters I expected ScI factor 2 to relate more with the emotion-driven impulsivity.

Maybe the use of CM is creating some confusion here as it may tap into both factor 1 and factor 2. Or factor 1 and/or factor 2 can share both types of impulsivity?

I’d welcome a clarification on this.

Chapter 28. Risk for Criminal Recidivism: The Role of Psychopathy

Authors: Kevin S. Douglas, Gina M. Vincent, and John F. Edens

With some disclaimers, it is fair to state that psychopathy is an important and meaningful risk factor for subsequent antisocial behavior of many types, across many contexts, in many different types of people.

• Moderate predictive validity for PCL-R: in the “typical” settings (offenders, forensic patients, civil psychiatric patients) in which the PCL-R is used, there is support for a moderate-level association between psychopathy and recidivism, which is subject to moderating influences of differing types
• HCR-20 and LSI-R are better predictors of recidivism: in Gendreau and colleagues’ (2002; see also Gendreau, Goggin, & Smith, 2003) meta-analysis, the LSI-R outperformed PCL measures substantially in predicting general recidivism, and modestly in predicting violent recidivism.
  (…)
  Guy and colleagues showed similar bivariate effect sizes for the PCL-R/PCL:SV and HCR-20, but when both measures were included together in a regression model, the PCL-R/PCL:SV’s predictive contribution dropped to near zero, whereas the HCR-20’s contribution remained strong.
• PPI also predicts recidivism despite not having criminal items: the items of the PPI are less strongly imbued with crime- and violence-specific content. Despite this, the pattern of associations for the PPI factors with recidivism parallel those for the PCL measures—with much stronger associations for its behavioral deviance (SCI) features than its interpersonal–affective (FD) features (see Marcus, Fulton, & Edens, 2013; Miller & Lynam, 2012).
• Boldness more unrelated to crime: Boldness (when operationalized as PPI-FD) tends not to be strongly related to antisocial behavior (Marcus et al., 2013; Miller & Lynam, 2012), although in one study it was found to interact with disinhibitory tendencies (as indexed by PPI-SCI) to predict predatory aggression (Smith, Edens, & McDermott, 2013).

Factor 1 protects against IPV, factor 2 predicts it

Conceptually, the two main factors of psychopathy might be expected to show opposing relations with some types of partner violence. Primary (affective–interpersonal) deficits might ironically protect against this type of aggression because of an absence of normal affectional ties, whereas the antisocial deviance component, which includes items reflecting impulsiveness and reactive aggression, would be expected to positively predict IPV. Studies of men in a correctional facility with a history of IPV (Hilton, Harris, Rice, Houghton, & Eke, 2008) or enrolled in treatment for domestic violence (Rock, Sellbom, Ben-Porath, & Salekin, 2013) have generally shown this to be the case.

Chapter 29. Treatment of Adults and Juveniles with Psychopathy

Authors: Devon L. L. Polaschek and Jennifer L. Skeem

The historic pessimism regarding the treatability of psychopathy (therapeutic pessimism) is not fully supported by empirical data, and high-quality, high-intensity interventions can demonstrate positive outcomes, especially for juveniles. The focus has shifted from “curing” the personality disorder to managing the risk and reducing antisocial behavior.

• Challenging Therapeutic Pessimism: Before reviewing these findings, we contextualize work to be reviewed by noting that conclusions of “nothing works with psychopaths” echo broader conclusions reached prior to the late 1980s regarding the treatment of criminal offenders in general. Since that time, research by an influential group of Canadian psychologists has convincingly demonstrated that some treatments do indeed “work” to reduce risk for recidivism.
• Modest but important impact: In general, the more programs adhere to the RNR model’s principles, the larger the reductions overall in reconviction risk. The impact on crime for those adhering to all three principles is modest but important, with reported effect sizes ranging from 0.15 to 0.34 (Andrews & Bonta, 2010). Even an effect size of 0.15 is notable. For example, if 50% of untreated offenders had been reconvicted at follow-up, the corresponding rate for treated offenders given a 0.15 effect would be 35%—a relative reduction of more than 30%.
• RNR 3 principles: treatment programs for offenders yield the largest reductions in criminal behavior when they (1) target relatively intensive services toward higher-risk offenders (the Risk principle), leaving lower-risk offenders with little or no therapeutic attention, (2) focus treatment services on changing empirically documented risk factors for crime (e.g., criminal attitudes, substance abuse, impulsivity), termed “criminogenic needs” (the Need principle), and (3) deliver interventions in a manner that maximizes offenders’ engagement in the treatment process and ability to use the treatment services to make changes (the Responsivity principle; Andrews et al., 1990; Andrews & Bonta, 2010; Bonta & Andrews, 2016).
• Intervention seems to work even with higher risk juveniles: Although it tends to be assumed that high-risk youth represent “the most hardened and least likely to respond to treatment” (Lipsey, Wilson, & Cothern, 2000, p.6), there is little support for this assumption. In fact, as compelling evidence to the contrary, Lipsey (2009) concluded from a meta-analysis of 548 controlled studies of programs for adolescent offenders published before 2002 that “there was no indication that there were juveniles whose risk level was so high that they did not respond to effective interventions” (Lipsey, Howell, & Kelly, 2010, p. 23). Instead, meta-analytic evidence indicates that core principles of effective correctional services for antisocial behavior—including the risk principle—generalize to young people (for a review, see Skeem et al., 2014).
• Poor behavior during treatment doesn’t mean ‘not effective’: although research indicates that offenders with high PCL scores tend to challenge the treatment process, the extant evidence shows they still profit in general from that treatment, and there is no support for the view that psychopathic traits per se pose any unique problems for treatment beyond features generally associated with high criminal risk.
• Group dynamics make a large difference in youth: Adolescents are also more driven toward risk-taking when in the presence of peers than when alone (see Steinberg, 2009). Juveniles with psychopathic features are not immune to such influences. Youth with pronounced psychopathic features are likely to be integrated into delinquent peer groups (Kimonis, Frick, & Barry, 2004), commit crimes in groups (Goldweber, Dmitrieva, Cauffman, Piquero, & Steinberg, 2011), obtain low scores on measures of resistance to peer influence (Thornton, 2012), and engage in antisocial behavior that is significantly predicted by peer delinquency (if modestly less so than those with low-moderate psychopathic features; Kerr, Van Zalk, & Stattin, 2012).1 The point is that juvenile offenders with psychopathic features are—first and foremost—juveniles.
• Factor 2 psychopaths attend more, but results were similar: They found that offenders classified into a subgroup reflecting secondary psychopathy attended treatment more reliably and showed higher treatment motivation than offenders classified into a primary psychopathy subgroup, but no differences between these groups were found on disruptive behavior or skill mastery, or on the proportion of group members judged to be “treatment successes” (Poythress and colleagues, 2010, p. 396).
• Focus alone may also help reverse some psychopathic deficiencies: treatment innovation efforts may also benefit from findings of recent neuroscience-informed research. For example, Dadds and colleagues (2006) demonstrated that observed deficits in recognition of fearful facial expressions were reversed for children with callous–unemotional traits when they were told to “pay attention to the eyes.” This finding suggests that recognition of others’ distress can potentially be remedied using a basic behavioral manipulation.

Chapter 30. Legal and Ethical Issues in the Assessment and Treatment of Psychopathy

Authors: John F. Edens, John Petrila, and Shannon E. Kelley

“Psychopathy” is a term frequently used in court, raising debates because it lies at the heart of fundamental legal questions concerning the restraint of liberty (e.g., civil commitment), the imposition of the death penalty, and the reliability of expert testimony. The central ethical concern is the potential for the diagnosis to be misused, leading to a presumption of incorrigibility and disproportionate sentencing.

Chapter 31. Understanding, Assessing, and Addressing Psychopathy: A Coordinated Agenda

Authors: Dustin B. Wygant, Dustin A. Pardini, Abigail A. Marsh, and Christopher J. Patrick

The future of psychopathy research must move beyond simply documenting associations to focus on clarifying underlying etiological influences, refining assessment methods through a dimensional lens (like the Triarchic model), and developing more effective, targeted interventions. The agenda emphasizes integrating neurobiological data with phenotypic traits to advance a deeper and more practically useful understanding of the disorder.

• The RDoC Framework to replace DSM: the National Institute of Mental Health’s (NIMH) Research Domain Criteria (RDoC) project (Cuthbert & Kozak, 2013), which seeks to establish a new classification system for mental illness based on neuroscientific knowledge of behavior, to replace the current DSM system. Specifically, the RDoC project calls for psychopathology researchers to investigate transdiagnostic symptom dimensions rather than specific disorders, in terms of core biobehavioral processes (i.e., positive affect, negative affect, cognition, social interaction, arousal/bodily regulation) quantified using variables from multiple domains of assessment (e.g., genetic, molecular, neuroanatomic, physiological, behavioral, self-report).

SHARPEST INSIGHTS

These are the insights that struck us the most.
We use the authors’ quotes and research, but the titles and interpretations are our own—and may not reflect the authors’ intent.
Credit for the insight goes to them; blame for the interpretation is on us.

Psychopaths go For Quantity Rather than Quality

They tend to prize quantity over quality in intimate relationships, viewing romantic encounters as sources of fun (Jonason & Kavanagh, 2010) rather than as sources of commitment and intimacy (Ali & Chamorro-Premuzic, 2010).
To the extent that psychopathy has been linked to communal success, it has mainly been in relation to having multitudinous (typically short-term) sexual partners (Hare, 2003; Jonason, Li, Webster, & Schmitt, 2009; Jonason, Valentine, Li, & Harbeson, 2011). Though this kind of sexuality may theoretically result in greater reproductive success (Nadelhoffer & Sinnott-Armstrong, 2010; Wiebe, 2004), it has yet to be established empirically whether this is actually the case (Gladden, Figueredo, & Jacobs, 2009; Glenn, Kurzban, & Raine, 2011). As successful as individuals with psychopathic traits may be in poaching others’ sexual partners, they also appear more vulnerable to having their own sexual partners poached, yielding a net neutral effect on their reproductive fitness (Jonason, Li, & Buss, 2010).

Also read:

• Psychopath’s sexual strategy: a deep dive

Conscientiousness Differentiates Successful vs. Unsuccessful Psychopaths

From chapter 12.
Note that this is based on personal reflections based on personal experience, not measured or lab-tested, but logic and studies (quote right after) seem to back it up:

Mullins-Sweatt, Glover, Derefinko, Miller, and Widiger (2010) surveyed clinical psychology professors, criminal attorneys, and forensic psychologists, asking them if they had ever personally known a psychopathic person who had been successful in his or her psychopathic endeavors—and if so, to characterize the person using trait descriptors. Persons so identified exhibited the antagonistic traits of deceitfulness, arrogance, manipulativeness, lack of remorse, callousness, and egocentricity, but they were high rather than low in Conscientiousness, which is associated with a number of positive life outcomes (Ozer & Benet-Martinez, 2006).

However, studies seem to back it up:

Conversely, studies have also demonstrated a significant negative relationship between Conscientiousness and a history of arrests (e.g., Clower & Bothwell, 2002). The lack of deliberation, rashness, and incompetence that characterizes low Conscientiousness could very well contribute to an increased likelihood of being arrested and convicted for one’s criminal behavior.

Primary Psychopathy as a Deception Strategy

Mealey (1995) advanced an evolutionary psychology analysis of psychopathy in which primary psychopathy reflects a survival strategy that relies on cheating or defecting from groups after signaling cooperation.
Based on Mealey’s arguments, it follows that the mechanism for this survival strategy is conserved in the human genome and would occur at similar prevalence in all human populations. In contrast, secondary psychopathy reflects an adaption to environments with limited resources. In such situations, there will be a higher incidence of individuals employing a cheating strategy to gain an advantage when competing for resources, and such individuals would be situated disproportionately in the lower SES sector of society, where access to resources is limited.

Logarithmic Effects of Psychopathy?

Reviewed in chapter 15, The Cambridge Study in Delinquent Development shows large differences between those scoring 10 or more on the PCL:SV and the remainder of the study participants:

Lack of Conscience Alone Isn’t ‘Evil’, But Facilitates it

From Lykken’s chapter 2:

Unlike the ordinary sociopath, the primary psychopath has failed to develop conscience and empathic feelings (…) This essential peculiarity of the psychopath is not in itself evil or vicious, but, combined with perverse appetites, or with an unusually hostile and aggressive temperament, this lack of normal constraints can result in an explosive and dangerous package.

Boldness Needs Two More Traits for Antisocial Behavior

From Fawles’ chapter 5:

Boldness involves reward-seeking without fear, often linked to arrogance, defiance, emotional insensitivity, and excitement seeking. To explain antisocial and “mean” behaviors, at least two additional traits are needed: (1) lack of concern for others, reflecting poor attachments and low empathy, which can lead to exploitativeness, proactive aggression, guiltlessness, and mild callousness; and (2) antagonism, or active hostility toward others, promoting cruelty, destructive aggression, rebelliousness, and severe callousness.

However, fearlessness is a risk factor on its own:

Pardini (2006) presented findings from a study of adjudicated juvenile males and females, indicating that fearlessness represents a risk factor for callousness and severe violence. A mediational model revealed evidence of a path from fearlessness to lack of punishment concern to callousness to severe violence. Thus, fearfulness contributed to callousness through its association with lack of concern for punishment, and callousness in turn was predictive of increased violent behavior. Findings from this study provide compelling evidence for fearless temperament as a risk factor for meanness.

Dishibition also plays a role:

Dishinhibition + Low Fear

With good parenting and attachment, normal Behavioral Inhibition System (BIS), and the emergence of empathy and conscience, fearlessness can look similar to boldness from the triarchic model.
However, boldness is still likely to include some degree of narcissism, thrill seeking, and lack of emotional sensitivity (Skeem et al., 2011, p. 106), with a tendency for self-interested, mildly callous pursuit of rewards.

Fearlessness accompanied by a weak BIS, and thus a lack of behavioral restraint, would make negative developmental trajectories much more likely.

Is Psychopathy Even a Unitary Construct?

From chapter 8, reflecting on the lack of correlation between factor 1 and factor 2 in the PPI (contrary to the PCL-R’s stronger correlation):

FD and SCI were largely orthogonal (uncorrelated) in Benning and colleagues’ (2003) analyses, a finding buttressed by a subsequent meta-analysis (Marcus, Fulton, & Edens, 2013; see also Malterer, Lilienfeld, Neumann, & Newman, 2010). Given that many or most authors regard psychopathy as a classical syndrome, that is, as a set of covarying features, this surprising finding raises intriguing questions about the validity of the boldness construct and, perhaps more provocatively, the nature of the psychopathy construct itself.

And later, on how this concept surprised a field that believed in the syndromal nature of psychopathy:

This assumption appears to be widely held in the psychopathy literature. For example, Hare (1993) wrote that “psychopathy is a syndrome—a cluster of related symptoms” (p. 34; emphasis added). Nevertheless, the assertion that psychopathy is syndromal is challenged by findings that (1) the lower-order and higher-order dimensions of several well-validated self-report psychopathy measures, including the PPI/PPI-R (Lilienfeld & Andrews, 1996) and at least one other self-report psychopathy measure, namely, the EPA (see Few et al., 2013), do not display a consistent pattern of positive manifold (i.e., uniformly positive interrelations among subscales); and (2) two major factors of the and PPI and PCL-R show opposing associations with measures of internalizing psychopathology.

The authors propose (Lilienfeld, 2013; Lilienfeld & Fowler, 2006) that psychopathy is a “compound variable,” a constellation of largely independent subtraits that combine to form a meaningful trait complex (Berry, Sackett, & Wiemann, 2007), also called “emergent traits” (Hough & Schneider, 1996).

If this analysis is sound, they say, the answer to whether psychopathy is a true syndrome depends on how one defines psychopathy. When the term refers to ASPD and related models of largely “unsuccessful” psychopathy—highlighting disinhibition and strong affective detachment—psychopathy does appear syndromal.
However, when referring to Cleckley’s conception and similar models of largely “successful” psychopathy that emphasize boldness as central, psychopathy does not qualify as a classical syndrome, because boldness shows little relation to the other core psychopathy features (Marcus et al., 2013).

QUOTES

🙋🏼‍♂️ Lucio’s Analysis

Hare review of the PCL-R checklist

Hare has a financial interest in the Psychopathy Checklist-Revised (PCL-R), as he receives royalties from its use. A financial stake does not automatically imply bias, but it is a well-known source of potential bias, even if unconscious.

Past behavior, including responses to criticism and alleged attempts to block publication of critical research may even lend credibility to possible bias as they appear defensive of the PCL-R.

Cues to Hare’s Defensiveness of PCL-R

I had first noticed some defensiveness in Hare’s response to Ronson’s book ‘The Psychopath Test‘.

Then from chapter 28 of this handbook:

in Gendreau and colleagues’ (2002; see also Gendreau, Goggin, & Smith, 2003) meta-analysis, the LSI-R outperformed PCL measures substantially in predicting general recidivism, and modestly in predicting violent recidivism. Hemphill and Hare (2004; see also Hare, 2003) sought to rebut these findings on methodological grounds, and reanalyzed most of the studies from Gendreau and colleagues’ meta-analysis that directly compared the LSI and the PCL. Although their reanalysis yielded markedly different results regarding the relative superiority of the LSI, neither meta-analysis reported statistical tests of incremental validity for the two measures.

And linked to potential bias, Hare also seems to actively promote the PCL-R efficacy.
Quoting from chapter 30:

It is also asserted that “most clinicians who participate in this [in-house] training should have little difficulty in conducting reliable PCL-R assessments” (Hare, 2003, p. 18), although we are aware of no published research specifically examining the efficacy of any particular training program.

Many researchers avoid speaking with absolutes or sounding too self-assured, and would rather quote evidence to back up strong claims. It’s noteworthy that Hare seems to express such strong confidence in his PCL-R without backing it up with credible research.

Criticism of PCL-R Only Appears In Other Chapters

For example, from chapter 13:

Hare assumed a unitary model of psychopathy, so the process of pruning the initial item pool into the final PCL item set led to the exclusion of most of Cleckley’s items related to positive adjustment (because they reduced internal consistency) and to the inclusion of items more explicitly related to criminal behavior (due to higher correlations with traits associated with social deviance; Patrick, 2006). As a consequence, there was some drift away from the Cleckley prototype, such that the PCL-R appears to index a construct more similar to the severe ASPD-subtype conception of psychopathy. For example, in prisoner samples, the prevalence “of ASPD is commonly 50%, whereas the prevalence of prisoners meeting the diagnostic cutoff for psychopathy using the PCL-R is often 25%, with nearly all of the PCL-R—defined psychopaths nested within those who meet criteria for ASPD (Hare, 1996, 2003).

Deprioritizing Cleckley’s Accounts For More Empirical Evidence?

In some passages, I felt like Cleckley’s original descriptions were used to justify or explain more modern theories, including providing a rationale for the concept of boldness in the triarchic model.
For example:

boldness maps largely onto what Cleckley described as the “mask” of superficially healthy adjustment (but see Miller & Lynam, 2012, for a 183 dissenting view)
(…) Moreover, noteworthy elements of boldness can be found in several of Cleckley’s other criteria for psychopathy.

These notes are interesting and do add some value.
However, I worried that Cleckley’s observations may not have too large an impact on modern theories, and that some concepts weren’t also thought out to retrofit Cleckley’s original accounts.
I’d rather the field move and rely on empirical findings alone, instead.

Suggestions for the Editor and Authors

Starting from a position of excellence, these are simply ideas that could make an already strong handbook even more to an audience such as myself:

Thematic consolidation by chapter-topic

Let me preface this that this book is already doing this well, and better than many other handbooks I’ve studied.

That said, there may be some extra room to make each chapter even tighter around a specific topic, and avoid repeating the same information in other chapters.

For example, chapter 7 on Callous-Unemotional traits could combine with chapters 19/20 on children and adolescents.
Various mentions to DSM could also be combined into Chapter 12 only.

And various mentions to Ckleckley and his pioneering work could be omitted from some places, epscially in light of the more recent findings available today.

This could tighten the book around stronger, core chapters, and free up enough space to then:

Cover some basics

• A clear comparison between major diagnostic tools (ie.: PPI vs PCL-R), discussing the different items, forensic vs. non-forensic use, and why Factors 1 and 2 correlated in the PCL-R, but not in the PPI. Understanding this for example helped me evaluate whether antisociality is truly a core psychopathic feature rather than an artifact of PCL-R
• Brief primers on commonly cited physiological markers such as ‘fear-potentiated startle’ and skin conductance, explaining how they are measured and why they matter (at first I wondered why it’s startle potentiation than matters, rather than simple startle response)

Provide a ‘researcher-community’ overview

Some of us non-researchers turn to handbooks for an integrated overview of the full literature in a single volume.
And it would add immense value to know where the broad research community stands on certain open and debated issues.

For example, do most researchers today believe that antisociality is a core component of psychopathy? Do most researchers consider PPI a better measurement than PCL-R? Do most researchers prefer the triarchic model over factor 1/factor 2 from PCL-R? Or do they regard the PPI’s factors as better descriptors of psychopathy as a whole, not limited to prison populations?

I am aware there may not be an easy quantitative metric to capture field-wide consensus. However, even general impressions from well-positioned researchers, for example cautiously presented in a side box, would add substantial practical value for readers trying to understand where the field currently stands.

Clarify the role of IQ as a moderator for antisociality/violence

I was interested in this area of research and was first surprised by chapter 24’s findings that IQ didn’t seem to have a stronger moderator effect.

However, Chapter 25 then seemed to suggest a stronger role of IQ in moderating violent behavior, even as it ends by implying it may be due to better evading conviction rather than not engaging in it.

Chapter 24 instead seems to downplay the role of intelligence in moderating antisocial behavior for successful psychopathy (evidence for model 2 of successful psychopathy). Even if IQ helps evade conviction, from an amoral point of view, that would still boost the case for ‘successful’ psychopathy at least from an individual fitness point of view.

REVIEW

The Handbook of Psychopathy is one of the most comprehensive and rigorous syntheses of modern psychopathy research to date, and it provided an important empirical foundation for our articles and lessons on psychopathy.

I am grateful to the authors for their rigorous work and look forward to following their progress as they continue to move the field forward.