Any fan of true crime shows understands the mystique surrounding psychopaths. It is not clear exactly what the appeal is, but there is certainly something fascinating about otherwise unassuming or charismatic characters – people we may live near, speak to in the office, or sit next to on the train – who turn out to be capable of the most remorseless and depraved acts. The internal world of these individuals feels inscrutable, which makes them perfect for our morbid speculations and interpretations – what were they thinking? How could they do that? Why, just why?

But despite the ubiquity of these terrifying people in popular culture, the most amazing thing about “psychopaths” is that they don’t really exist. Or should I say, not in the way that is usually understood. 

Not like you or me

There is a video currently doing the rounds on TikTok explaining how “psychopaths” respond to stress. The footage was posted by user @everythigmentalissues in June 2023, and has already received over 7 million views. In it, an unidentified psychologist (who is actually Dr Ramani Durvasula, an American clinical psychologist) explains how research into psychopaths or those with an “antisocial personality disorder” respond to stress differently from everyone else. 

According to that video, it all has to do with our autonomic nervous system, the part of our body that reacts to threatening situations. When the brain recognizes or suspects a threat, the amygdala sends a signal to the hypothalamus which, in turn, signals the autonomic nervous system to prepare for action. It does so by triggering a response from the sympathetic nervous system which releases epinephrine (adrenaline) into our blood streams. This is what gets our hearts racing and makes us alert. Essentially, it’s what primes us for the fight, flight, or freeze response. Or that’s how it is meant to work. 

According to the TikTok, psychopaths do not respond in quite the same way. According to Dr Durvasula, when a “normal person” breaks a rule, or does something embarrassing or rude, they get “charged up” and their heart rate rises. However, “A psychopath doesn’t have that same kind of arousal”, she says. “That’s why they’re able to lie on lie detector tests – that’s how they get away with it”. 

Ultimately, Dr Duvasula states, psychopaths “don’t feel remorse when they do something bad” and they don’t get stressed “in the same way” as other people. She concludes that “Psychopaths and to some degree sociopaths don't think about consequences."

The explanation here is certainly fascinating and does match the findings of some empirical research (though none is provided in the post). The problem is that it also oversimplifies things to the extent that they are misleading. 

Are psychopaths really “out there”?

Firstly, and importantly, the term “psychopath” is not one that is recognized by many psychologists. For instance, the Diagnostic and Statistical Manual (DSM), the categorization bible of the American psychological community, does not include psychopathy within its diagnostic classification, and professional bodies like the World Health Organization (WHO), the American Psychiatric Association and many others do not use the term either. There are a few reasons for this, but an important one relates to the idea of an “evil person” and the possibility of treatment/help. 

The definition of an “evil person” relies on cyclical logic where evil acts are performed by an evil person simply because they are evil and do evil things. It’s unhelpful and explains very little. The diagnosis of “psychopath” produces the same outcome but with a medicalized veneer. The term is emotionally loaded and risks giving an individual experiencing mental health conditions a label that places them beyond help. 

“Far from being a useful description,” Gabriel C. S. Gavin wrote in Psychology Today, the term “’psychopath’ conjures up the perfect image of someone you wouldn’t be desperate to help, someone as inhuman as those previously branded evil.”

The term also squashes together various behaviors and activities that are actually quite separate. It’s a convenient mesh, Gavin notes, that can be stretched to include anyone from serial killers and the perpetrators of genocide to Wall Street bankers or that ex who upset you. But in recent years, the term has also become associated with criminal categories.

"The concept of psychopathy was historically used as a catch-all term for all sorts of mental health conditions," Dr Xander Mach, a psychologist and mental health consultant whose focus is on improving outcomes and practices when treating diverse communities, told IFLScience, “and in more recent history has been used in criminology to try to predict future criminal behavior.”

For Mach, this association between a clinical diagnosis and a criminal categorization has negative implications. “Measurements of 'psychopathy' generally appear to be a very weak predictor of criminal behavior”, he added. 

“Being given a high score on a psychopathy scale in the criminal justice system could easily be used to draw empirically dubious conclusions that the person in question will not respond to treatment and/or is not able to be rehabilitated. To me, the comparison advances mental health stigma, particularly where personality diagnoses are concerned. That may create additional barriers for people in finding dignified and appropriate care for their mental health condition(s).”

So how do psychologists and psychiatrists approach the types of people we would think of as “psychopaths”? Well, antisocial personality disorder (ASPD), which Dr Durvasula mentions in the TikTok, is applicable here. People with ASPD are often resistant to rules, ignore right and wrong, lie, manipulate, and show little remorse. But rather than being a concrete category like “psychopath”, this disorder functions as a spectrum, which means it can range in severity from occasional poor behavior to outright criminal activities and repeated rule-breaking. 

The important point here is that someone can have “psychopathy” but not be a “psychopath”. The human personality is complex and multifaceted rather than being easily designated as one thing or another. Or, as Dr Scott Barry Kaufman noted on Twitter (or X, or whatever we are calling it now): 

“Psychopaths don't exist. All that exists are humans with differing levels of typically-expressed psychopathic personality traits. Same for everything listed in the DSM. Humans aren't dichotomous categories; we each express some level of each classification at some point.”

ASPD is estimated to affect between 0.6 percent to 3.6 percent of adults. In many instances, people with the disorder also have co-occurring mental health conditions such as depression, anxiety, bipolar disorder, and substance abuse. 

There are also issues with the existing research into psychopathy more generally. Firstly, so Dr Mach explained: 

“There is so much symptom overlap among personality diagnoses and so much bias in 1) the history of those diagnoses and 2) which diagnoses are assigned to whom that it’s really hard to take a lot of the findings as full and accurate representations. (Hell there’s even symptom overlap between personality diagnoses and other conditions like mania, hypomania, ADHD, brain damage/dysfunction, etc.)”

Mach also pointed out that “A lot of the science in this area is on cisgender men. And diagnostically cis men are 3x more likely to be given the diagnosis”.

“Similarly, other personality diagnoses like histrionic and borderline personality disorder are more likely to be diagnosed in cis women — even though aggression and interpersonal manipulation can be highly prevalent features of the latter.”

Crucially, those with ASPD are not beyond hope. There are a range of treatments available depending on the individual, which can include, Mach says “trauma-focused treatments, dialectical behavioral therapy, cognitive behavioral therapy, and substance use treatment (as substance use can be a common comorbidity exacerbating other symptoms).”

The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.   

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