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Will the Real Psychopath Please Stand Up?

Craig Neumann, Professor of PsychologyPsychopathy refers to a pathological personality disposition that involves charm, manipulation, and ruthless exploitation of others. Psychopathic persons are lacking in conscience and feeling for others; they selfishly take what they want and do as they please without the slightest sense of guilt or regret (Hare, Neumann, & Widiger, 2012). While psychopathic individuals can often act in an impulsive and reckless manner, at other times they can behave with instrumental aggression (Vitacco, Neumann, Caldwell, 2010). Psychopathy is among the oldest and arguably the most heavily researched, validated, and established personality disorder. Thus, it is not surprising that there has long been an interest and effort to provide an adequate description of the personality structure of psychopathy.

Hervey Cleckley (1941, 1976) wrote perhaps one of the most influential clinical works on psychopathy titled, The Mask of Sanity. However, Cleckley’s work, while often viewed with great reverence, was essentially based on case studies, and thus fundamentally lacking in strong empirical backing (Hare & Neumann, 2008).  Similarly, an empirically supported conceptualization of psychopathic personality disorder has yet to be adequately represented in the current psychiatric classification system, though this is likely due to fundamental problems with the classification system rather than the diagnostic status of psychopathy per se (Hare, Neumann, & Widiger, 2012). More importantly, modern studies have begun to provide a clear and comprehensive articulation of the psychopathy construct (Patrick, 2006).

In research with my colleagues (e.g., Neumann, 2007; Neumann et al., 2006; Neumann & Hare, 2008; Neumann, Hare, & Newman, 2007), we have provided a wealth of empirical support for a four dimensional conceptualization of psychopathic personality disorder; one that has been developed via a sophisticated mathematical modeling approach across a wide diversity of samples and measurement approaches (Hare & Neumann, 2008; Neumann, Hare, & Newman, 2007; Neumann & Hare, 2008; Neumann, Schmitt, Carter, Embley, & Hare, in press). In this model (see Figure 1), psychopathy reflects a comprehensive set of characteristics that involve disturbances in Interpersonal (e.g., glibness, conning), Affective (calloused, lacking empathy), and Lifestyle (impulsivity, stimulus seeking) functioning, as well as overt Anti-sociality, which involves an inability to follow social proscriptions that may involve criminal acts, though this is not a necessity (Hare & Neumann, 2010).

Actor Anthony Hopkins as Hannibel Lecter in the film, The Silence of the LambsAlthough both the scientific and common culture literature on psychopathy has a long history, considerable confusion remains in many peoples’ minds about this pathological personality disorder. Images of such unforgettable characters as Anthony Hopkins as Hannibal Lecter, or the psychopathic killer, Anton Chigurh, from the movie No Country for Old Men provide the general public with a conception of the psychopath as a murderous madman. These media portrayals are not necessarily completely divorced from one potential picture of the psychopath, given the personality pathology is associated with an increased risk for violence (e.g., Leistico et al., 2008; Olver et al., 2012; Vitacco et al., 2005). However, the problem is that the psychopathic individual is not necessarily a lunatic, murderous, madman.

Paradoxically, as frightening as the media’s psychopathic characters may be, the empirical research suggests a potentially more sinister reality. Despite the media’s portrayal and the general publics’ conception of the psychopath as seemingly inhuman and fundamentally unlike most people, the empirical evidence from large-scale studies suggests that psychopathic traits are dimensional in nature and thus are continuously distributed from low to high, as opposed to being a categorical condition where one either has the disorder or does not (Guay, Ruscio, Knight, & Hare, 2007; Edens, Marcus, Lilienfeld, & Poythress, 2006). As such, individuals with psychopathic features are not only prevalent in offender samples (Hare, 2003), but are also present in samples from the general community (Neumann & Hare, 2008; Neumann & Pardini, in press) and the corporate world (Babiak, Neumann, Hare, 2010; Mathieu, Hare, Jones, Babiak, & Neumann, in press). Moreover, psychopathic traits have moderate genetic and environmental causal influences (e.g., Larsson et al., 2007; Taylor, Loney, Bobadilla, Iacono, & McGue, 2003; Viding, Frick, & Plomin, 2007). In terms of predictive validity, community studies find that psychopathic traits are linked to elevated levels of violence and alcohol use, as well as decreased intelligence (Neumann & Hare, 2008), criminal offenses and other externalizing psychopathology (Neumann & Pardini, in press), and problematic corporate behavior (Babiak et al., 2010).

New research suggests that psychopathic features among individuals from the general population are associated with brain activation patterns typically seen in forensic psychopathic samples (Carre et al., 2012). The prototypic psychopathic individual is a male offender, where the prevalence of psychopathy is estimated to be approximately 15-25% of male offender populations (Hare, 2003). Among individuals from the general population, the prevalence of individuals with elevated levels of psychopathic features is estimated to be approximately 1-2% (Neumann & Hare, 2008). As such, there is the statistical probability that many individuals within the general population have been exposed to other individuals with psychopathic features, and indeed, may have been greatly harmed from such exposure. My colleagues have developed a website which provides resources to help cope with such experiences (aftermath-surviving-psychopathy.org).

Despite this new research on psychopathy in general population samples, and the empirical realization that psychopathic traits can be manifested across a range of individuals within diverse settings, there remains considerable confusion both in the media’s and general publics’ conception of psychopathy. Why the confusion? First, the term “psychopathy” itself, and related terms have been inconsistently used in the scholarly community. For example, terms such as “sociopath,” “psychopath,” and “antisocial personality disorder” have all be used to refer to psychopathy, though the scientific operationalization of these disturbances is far from isomorphic (Hare, Neumann, & Widiger, 2012).

However, the verisimilitude of researchers operationalization of the psychopathy construct notwithstanding (Neumann, Uzieblo, et al., in press), the media’s portrayal of psychopathic persons is, I believe, a far larger part of the problem. For instance, during a TV episode of House (“Remorse,” Original Airdate, January 25, 2010) a ‘psychopathic’ woman is seemly diagnosed in terms of a single brain imaging session, and then ‘cured’ via correction of a supposed dietary disturbance. To date, the pathology of psychopathy is far too complex, and too little known for such a TV episode to have any credence whatsoever. Similarly, in a recent popular press book by John Ronson (The Psychopathy Test) the author manages to provide some mediocre semblance of entertainment as he hunts down and regularly spots psychopaths among us in all walks of life, though the research upon which the book is based is far from complete or accurate (see Hare.org for commentary on Ronson’s book). Not surprisingly, research on laypersons conceptualizations of psychopathy reveals that it is far removed from a valid understanding of the actual disorder (Furnham et al., 2009). I would propose this is due in large part to the general publics’ reliance on the media’s ungrounded portrayal of the psychopath, which is untethered from the empirical literature.

Psychopathy Checklist-Revised (PCL-R; Hare, 2003)Thankfully, in recent years, there has been a relative explosion of research on psychopathy. Below I present a quick sketch of research on psychopathy, using the National Library of Medicine’s search engine (PubMed), with respect to several other psychiatric or medical disorders. Table 1 displays a dramatic increase in psychopathy research across a 20-year span. In large part, the growth in research has occurred given the success of the Psychopathy Checklist-Revised (PCL-R; Hare, 2003), originally developed by my colleague Robert Hare. New PCL-based research has provided a wealth of insights on this personality pathology (Hare & Neumann, 2008), and in particular a better understanding of the moral brain in general, how psychopathic features might be linked to disturbances in moral behavior and related social emotions, and how psychopathy might be a particular case of the ‘moral brain’ gone wrong (Cardoso et al., 2012; Harenski et al., 2010; de Oliveira-Souza et al., 2008).

At the same time, along with providing these important insights into our moral nature, the psychopathy construct has been fundamentally important for prediction of violence in offenders (Olver et al., 2012), psychiatric patients (Vitacco et al., 2005), and individuals from the general community (Neumann & Hare, 2008; Neumann & Pardini, in press). As such, psychopathy is now considered to be perhaps the most important and useful psychological construct yet discovered for criminal justice policies (Harris, Skilling, and Rice, 2001), and what may be the most important forensic concept of the early 21st century (Monahan, 2006). Needless to say, it remains essential that research on psychopathy continue, but even more so, it would behoove both the media and the general population to seek out the empirical literature on this pathological personality disorder (see Hare, 1993, for a good basic starting point on psychopathy, as well as Patrick, 2006, for recent in depth coverage on the topic).

In terms of cutting edge research on psychopathy and related conditions, I was fortunate to present some exciting new research with my colleagues in the Netherlands this past summer, given the Dutch government has decided to systematically fund research on this pathological personality disorder (http://www.efp.nl/en/jubilee-conference). The research presented this summer in Utrecht can be found at, http://www.efp.nl/jubileumcongres/presentaties.

PubMed (search results, 9/17/2012)

Search Term:

Date of Publication Hypertension Psychopathy Schizophrenia Obesity
1990 7344 164 1540 1699
2010 14246 400 4297 12878
2010-1990 6902 236 2757 11179
% Increase 93.98% 143.90% 179.03% 657.98%

Figure 1

Mathematical Structural Model of Psychopathy (Neumann & Hare, 2008)

Mathematical Structural Model of Psychopathy (Neumann & Hare, 2008)





Babiak, P., Neumann, C. S., & Hare, R. D. (2010). Corporate Psychopathy: Talking the Walk. Behavioral Sciences and the Law, 28, 1-20.

Cardoso, A.S., Neumann, C.S., Roiser, J., McCrory, E., & Viding, E. (2012). Investigating associations between empathy, morality and psychopathic personality traits in the general population. Personality and Individual Differences

Carre, J., Hyde, L., Neumann, C. S., Viding, E., Hariri, A. (in press). The neural signatures of distinct psychopathic traits. Social Neuroscience.

Cleckley H. 1941. The Mask of Sanity. St. Louis, MO: Mosby

Cleckley H. 1976. The Mask of Sanity. St. Louis, MO: Mosby. 5th ed.

de Oliveira-Souza R, Hare RD, Bramati IE, Garrido GJ, Azevedo Ignácio F, Tovar-Moll F, Moll J. (2008). Psychopathy as a disorder of the moral brain: fronto-temporo-limbic grey matter reductions demonstrated by voxel-based morphometry. Neuroimage, 40, 1202-13.

Edens, J. F., Marcus, D. K., Lilienfeld, S. O., & Poythress, N. G. (2006). Psychopathic, not psychopath: Taxometric evidence for the dimensional structure of psychopathy. Journal of Abnormal Psychology, 115, 131–144.

Furnham, A., Daoud, Yasmine, Swami, V. (2009). “How to spot a psychopath” Lay theories of psychopathy. Social Psychiatry & Psychiatric Epidemiology, 44, 454-472.

Guay, J. P., Ruscio, J., Knight, R. A., & Hare, R. D. (2007). A taxometric analysis of the latent structure of psychopathy: Evidence for dimensionality. Journal of Abnormal Psychology, 116, 701–716.

Hare, R. D., (1993).Without Conscience: The Disturbing World of the Psychopaths Among Us. Guilford Press.

Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, Ontario, Canada: Multi-Health Systems.

Hare, R. D. & Neumann, C. S. (2010). The role of antisociality in the psychopathy construct: Comment on Skeem & Cooke. Psychological Assessment, 22, 446-454.

Hare, R. D., & Neumann, C. S. (2008). Psychopathy as a clinical and empirical construct. Annual Review of Clinical Psychology, 4, 217-46.

Hare, R. D., Neumann, C. S., & Widiger, T. (2012). Psychopathy. T. Widiger (Ed.) Oxford Handbook of Personality Disorders. Oxford University Press

Harenski CL, Harenski KA, Shane MS, Kiehl KA. (2010). Aberrant neural processing of moral violations in criminal psychopaths. Journal of Abnormal Psychology, 119, 863-74.

Harris, G. T., Skilling, T. A., and Rice, M. E. (2001). The construct of psychopathy. Crime and Justice; 28: 197–264.

Larsson, H., Tuvblad, C., Rijsdijk, F. V., Andershed, H., Grann, M., & Lichtenstein, P. (2007). A common genetic factor explains the association between psychopathic personality and antisocial behavior. Psychological Medicine, 37, 15–26.

Leistico, A. R., Salekin, R. T., DeCoster, J., & Rogers, R. (2008). A large-scale meta-analysis relating the Hare measures of psychopathy to antisocial conduct. Law and Human Behavior, 32, 28–45.

Mathieu, C., Hare, R. D., Jones, D. N., Babiak, P., & Neumann, C. S. (2012, July 9). Factor Structure of the B-Scan 360: A Measure of Corporate Psychopathy. Psychological Assessment. Advance online publication. doi: 10.1037/a0029262

Monahan, J. (2006). [Comments on cover jacket]. In C. J. Patrick, (ed.), Handbook of psychopathy. Guilford Press, New York.

Neumann, C. S. & Pardini, D. (In press). Factor Structure and Construct Validity of the Self-Report Psychopathy (SRP) Scale and the Youth Psychopathic Traits Inventory (YPI) in Young Men. Journal of Personality Disorders.

Neumann, C. S. Psychopathy. (2007). British Journal of Psychiatry, 191, 357-358.

Neumann, C. S., Hare, R. D., & Newman, J. P. (2007). The super-ordinate nature of the psychopathy. Special Section on Psychopathy: Journal of Personality Disorders, 21, 102-117.

Neumann, C. S., Kosson, D. S., Forth, A. E., & Hare, R. D. (2006). Factor structure of the Hare Psychopathy Checklist: Youth Version (PCL:YV) in incarcerated adolescents. Psychological Assessment, 18, 142-154.

Neumann, C. S., Schmitt, D. S., Carter, R., Embley, I., & Hare, R. D. (in press). Psychopathic traits in females and males across the globe. Special Issue on female psychopathy: Behavioral Sciences and the Law

Neumann, C. S., Uzieblo, K., Grombez, G., & Hare, R. D. (In press). Understanding the Psychopathic Personality Inventory (PPI) in terms of the Unidimensionality, Orthogonality, and Construct validity of PPI-I and –II. Personality Disorders: Theory, Research, and Treatment.

Olver, M. E., Neumann, C. S., Wong, S. C. P., & Hare, R. D. (in press). The structural and predictive properties of the Psychopathy Checklist-Revised in Canadian aboriginal and non-aboriginal offenders. Psychological Assessment.

Patrick CJ, ed. 2006a. Handbook of Psychopathy. New York: Guilford

Taylor, J., Loney, B. R., Bobadilla, L., Iacono, W. G., & McGue, M.(2003). Genetic and environmental influences on psychopathy trait dimensions in a community sample of male twins. Journal of Abnormal Child Psychology, 31, 633–645.

Viding, E., Frick, P. J., & Plomin, R. (2007). Aetiology of the relationship between callous-unemotional traits and conduct problems in childhood. British Journal of Psychiatry, 190(Suppl. 49), s33–s38.

Vitacco, M., Neumann, C. S., & Jackson, R. L. (2005). Testing of a four-factor model of psychopathy:  Associations with gender, ethnicity, intelligence and violence.  Journal of Consulting and Clinical Psychology, 73(3), 466-476.

Vitacco, M.J., Neumann, C.S., & Caldwell, M.F. (2010). Predicting antisocial behavior in high-risk male adolescents: Contributions of psychopathy and instrumental violence. Criminal Justice and Behavior, 37, 833-846.