Psychopathy: evidence that it is easier to build strong children than to repair broken men

It is a Sunday and Sundays are traditionally associated with some free time to relax. I will suggest that you do something which fits into the general description of a Sunday afternoon, like watching a movie. Especially if psychopaths fascinate you.

It will not be nice, nor relaxing. It will make you feel things and even more so – think about things, but it will not leave you with a light heart and pleasant sensation. It will, however, help you see through the eyes of a young psychopath and get a feeling of how he sees the world. I promise, it is worth the 2-hour commitment. Hopefully you will be more curious to read this blog post afterwards!

Open your favourite official movie streaming website and find We need to talk about Kevin (2011).

My advice: pay close attention while watching because 1) the story doesn’t follow a straight sequence and 2) the underlying visual effects are ingenious and they are part of the reason why this movie is, in my opinion, a masterpiece.

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Keep an eye out for my favorite scene to which this Campbell’s tomato soup pays tribute!  source: flickr (CC BY-NC 2.0)

The movie tells the story of the complex relationship between a mother and her son who is manifesting psychopathic traits. It illustrates the ultimate power game orchestrated by the young boy over his mother. Furthermore, it brings up many questions related to the origins of this type of personality disorder and the ways it should be understood.

Whatever the reasons for the root of this disorder is, the last scene conveys an essential message: these people are human beings who, in their own way, suffer. This leaves us to understand where the differences between “us” and “them” are, accept them and try to find ways to decrease their suffering as well as the suffering of those people who surround them.

Could you spot a psychopath?

Currently, the terms antisocial, sociopathic and psychopathic are grouped under the common category of Antisocial Personality Disorder in the DSM 5 (the most widespread classification and diagnostic tool used in psychiatry). However, many psychiatrists, criminologists and other scientists are not satisfied with this classification. Admittedly, they point out that these disorders have a huge overlap of symptoms and personality traits, but they also present distinct sets of characteristics which are specific to each personality type. As R. J. Blair points out, only one third of those who are diagnosed with antisocial personality disorder meet criteria for psychopathy. In accordance with this suggestion, recent neuroimaging studies have started to show that people diagnosed with psychopathy have specific patterns of activation in several brain regions which distinguish them from other similar disorders.

Personality traits commonly associated with psychopathy (as assessed by the most common clinical diagnostic tool, the Hare Psychopathy Checklist-Revised or PCR) can be broadly organized in 4 groups:

  • Antisocial behavior: lack of consideration for the feelings and well-being of others, disregard of social norms and laws (e.g. driving a car too fast for personal satisfaction, vandalism, street drinking, bullying, destruction of property, lying, etc.).
  • Interpersonal relationships: inflated notion of self-importance, goal-directed manipulation (towards obtaining social status, money, sexual opportunities, etc.) and superficial charm.
  • Affective and emotional: callous and unemotional attitude, lack of empathy, limited emotional responsiveness and absence of feeling of responsibility, regret or guilt for their actions.
  • Lifestyle: lack of realistic long-term goals, short and shallow relationships, constant pursuit of highly stimulating experiences, impulsive decisions, etc.

How to better spot a psychopath and why?

The more research advances, the stronger the evidence becomes that psychopathy is a developmental disorder. Although a person under 18 cannot be diagnosed with psychopathy, they can be diagnosed with Conduct Disorder (CD). Also, a person over 18 cannot be diagnosed with psychopathy unless they have been diagnosed with CD during their childhood/adolescence.

Conduct Disorder is a somewhat “generic” and temporary term which opens the gates towards diverse diagnoses once the person turns 18. However, there are several signs which almost without a doubt point to the direction of psychopathy. One of these markers is the presence of callous-unemotional traits. This is the only dimension of psychopathy which is incorporated in the DSM 5’s diagnostic criteria for CD. However, a recent paper by R. Salekin suggests that the presence of two other dimensions, in combination with callous-unemotional traits, strongly correlates with the evolution towards the diagnosis of psychopathy: grandiose–manipulative and daring–impulsive traits. Unfortunately, these dimensions are not covered in the diagnostic criteria of the DSM 5. In clinical practice, it would be beneficial to be able to detect, quantify and follow-up on these dimensions for several reasons. Firstly, it would allow clinicians to identify children/adolescents who present the entire “psychopathic” syndrome more accurately. Secondly, clinicians could adapt the treatment strategies to the needs of each child, depending on which dimension is more or less problematic. Finally, better and more systematic characterization of the behavioral expressions of these three dimensions will allow a more in-depth study of the different biological and psychological mechanisms which underlie them.

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Antisocial personality disorder is a broad category, within which several different sub-profiles can be identified (and none of them is as funny as these clowns). Pixabay (CC0 1.0)

What makes the brain of a psychopath?

One of the most distinctive characteristics of psychopaths is the systematic use of instrumental aggression. It differs from reactive aggression by the fact that it is goal-directed and unsolicited by any frustrating or threatening circumstances. A review paper by R. J. Blair sums up the results of several important studies examining the anatomical correlates of reactive and instrumental aggression.

When it comes to structural characteristics, data is divergent. The only consistent finding relates to the amygdala (a communication hub for processing of all types of emotional information, especially fear-related). For instance, Tiihonen et al. demonstrate that forensic populations with high scores on Hare’s PCR present up to 21% smaller amygdaloid volumes compared to inmates with low scores.

Concerning functional characteristics of the psychopathic brain data is more consistent. Common tasks used to study the brain activations of individuals with high psychopathy scores include reading and processing of words with neutral/positive/negative valence, presentation of faces expressing different emotions, emotional memory, moral decision-making, etc. While doing these tasks, people with high scores on psychopathic traits show reduced activation in the amygdala and the orbitofrontal cortex. In contrast, individuals with high scores on reactive aggression show elevated activation in those regions. Therefore, a functional signature of regions involved in emotional processing, decision making and action control in people with psychopathic traits has been demonstrated. These observations provide us with biomarkers of psychopathy: decreased activations in the amygdala and the OFC in response to emotional stimuli which is not observed in any other patient population.

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Approximative representation of what the functional brain signature of a psychopath looks like! Pixabay (CC0 1.0)

 

Coming back to Kevin

One might ask oneself whose fault it is that children grow up to become psychopaths and some people have the intuitive reaction to blame the parents. There is evidence that individuals with high scores on psychopathic personality scales have experienced higher levels of childhood neglect and/or abuse compared to those with low scores on psychopathic personality. But there is another side of the coin which is often neglected: the influence that a child’s behavior can have on the parenting style of the caregiver. For example, O’Conner at al. investigated the development of psychopathic tendencies of adopted children as a function of their genetic risk to develop the disorder (in this case, evaluated according to the antisocial behaviors self-reported by the biological mothers before birth). Their data showed that children with higher genetic risk receive more negative parenting from their adoptive parents than children who were not at genetic risk. Therefore, to better grasp the dynamics of this complex personality disorder people should start considering the bidirectional parent-child effects rather than focus on a single side.

Tuvblad et al. carried out a thorough longitudinal study on 1562 monozygotic twins and their parents in order to investigate the potential bidirectional and environmental effects influencing antisocial behaviors and parenting styles. They assessed parenting styles and psychopathic personality traits at two time points, first when the twins were 9-10 years old and second when they were 14-15 years old. Their results lead to two main conclusions:

  • There is a parent-driven effect on the development of psychopathic traits in children: negative parent-to-child affects observed at age 9-10 correlate positively with psychopathic traits in children at age 14-15, regardless of whether the children exhibited psychopathic traits at the first time point or not.
  • There is a child-driven effect on parenting style: psychopathic personality at age 9–10 years influence negative parent-to-child affect at age 14–15 years.

As much as it is important to keep in mind the significance of this parent-child-environmental-genetic quid-pro-quo, the vast majority of studies still points to the importance of secure and nurturing parenting during childhood. After all, as Frederick Douglass wisely said, it is easier to build strong children than to repair broken men. If children are taught by their parents in what ways they are different from the others and shown the right ways to regulate their behavior, they can grow up to be successful surgeons, negotiators, pilots or any other profession requiring a clear mind, non-blurred by emotions. The key to success is awareness, kindness and education.

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Even if a child manifests psychopathic traits – there is hope! Parents should not be afraid to contact health professionals such as psychologists to seek advice on how to best teach their children to face the world and accompany them on their path to living with “normal” people!  Artist: Heinrock, no changes were made source: flickr (CC BY-NC-ND 2.0)

 

Author’s notice: check out this website for current research, advice and support on the forum by people who are or who have experienced contact with psychopaths.

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