The birth of a psychopath

2014: Doctor says psychopaths can't change
2014: Doctor says psychopaths can't change

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Story highlights

  • Psychopaths have a distinct lack of remorse for their own bad actions and a failure to accept responsibility
  • For the violent psychopath, an early sign might be cruelty to animals or complete lack of caring for other children

(CNN)After every horrific crime that shocks us, the next question we often ask is, "How could anyone do such a thing?"

If the criminal is a psychopath, the answer is very simple. They don't feel empathy or guilt. So instead of asking, "How could they do this horrible thing?" the more pertinent question might be, "When did they start doing horrible things?"

What defines a psychopath

Psychopaths are pathological liars, manipulators, and charmers. They have a distinct lack of remorse for their own bad actions, a failure to accept responsibility for the same, and an overall lack of empathy. They are impulsive and irresponsible, seeking constant stimulation. Many are horribly violent and their motives "more commonly will involve sadistic gratification," according to an FBI bulletin devoted to the disorder. "The psychopath is an intraspecies predator," it reads.
Psychopaths are found in every country, belong to every race, and the majority are men. According to several studies, roughly 1% of the men in the United States are probably psychopaths, and they most likely exhibited signs at a very young age. Those signs are key -- there is no known cure for full-blown psychopathy.

An untreatable condition?

Researchers continue to search for a successful treatment plan, but "we don't have a therapy for it, and there's no known pill for psychopathy," said Mary Ellen O'Toole, a former FBI profiler who has written extensively about psychopaths.
Any attempt at therapy has to be carefully structured and monitored, particularly in the case of a criminal psychopath, as they are equipped with the skill and motivation to act more as a predator than a patient. They can easily identify weaknesses in their therapists and feign progress to shorten treatment.
Psychopaths don't seek out treatment on their own, said Robert Hare, who has studied psychopathy for more than 40 years and developed the scale used to measure it. He explained that psychopaths, not suffering any psychological or physical pain, don't believe there's anything about themselves that needs fixing.
What kind of treatment might a psychopath even receive? "You can try to train them to feel emotions," said Hare, "but that is like trying to train a cat to be a mouse. None of the programs seem to work except those that change behavioral problems. You might get them to look out for themselves in a different way, to develop an enlightened self-interest." And in order to do that, early detection is paramount.

Warning signs

"If you look back in the childhood of any offender you can find a long, long history," said Hare, who authored "Without Conscience: The Disturbing World of the Psychopaths Among Us." For the violent psychopath, an early sign might be cruelty to animals or complete lack of caring for other children, including teasing or even hurting them.
It goes beyond the typical arguments at school or scuffles between siblings. "The behavior has to be well outside the norm," Hare said. While children are not labeled psychopaths, the markers that predict a high probability a child will develop a psychopathic personality include many of the same characteristics: lack of guilt; lack of empathy; lack of concern about performance; and shallow or insincere emotions.
Over time, the behavior proves to be much more severe than typical childhood selfishness. Even compared with children with other behavior disorders or psychological issues, a child who has these traits and might be clinically labeled "callous-unemotional" will stand out to parents, teachers and peers.
Identifying a psychopath, or a child at risk for developing psychopathy, relies on examining his or her behavior and interacting with the child over lengthy interviews based on the checklists and scales developed by Hare. There is no quick medical test that can give a definitive verdict on whether someone is a psychopath, or to what degree.
However, functional magnetic resonance imaging scans have shown some functional differences in psychopaths' brains, particularly in the frontal cortex and limbic system.
Psychopathy is also an inherited condition, according to J. Reid Meloy, forensic psychologist and author of "The Psychopathic Mind." "The more severe the psychopathy, the greater the inheritance for the disorder," he said.
Hare agreed, adding, "There are genetic factors involved. There is enormous evidence indicating psychopathy is an interaction between genetics and the environment."

Early intervention

In the search for a treatment or management plan for psychopathy, "early intervention is really the only thing that's been shown to be effective," said Matt Logan, another leading researcher in the field and a former prison psychologist.
Intensive, regular, long-term intervention from both parents and teachers is key. Programs may use cognitive behavioral therapy, group therapy, or other methods. Because children showing high levels of the callous-unemotional traits also typically have very low levels of fear and anxiety, they usually don't have a positive behavior change from programs emphasizing discipline. They are more likely to respond well to positive reinforcement and reward-oriented programs.
Though there is some debate, many researchers believe it's important to recognize the children who need this specific, tailored help, even at the risk of a stigmatizing label like callous-unemotional, or later, psychopath. The goal, Hare said, "is to get these children to act more in line with what society expects."
And as Hare points out, "Not all psychopaths are criminals. They are in business, government, academia and media. You'll find lots of these people, but they're not committing criminal acts. They will take advantage of people."
Perhaps if potential psychopaths are given, at a very young age, the tools to get what they want within the laws and expectations of society, a greater number could live extraordinarily productive lives.