The Confusion Over Psychopathy (I): Historical Considerations

International Journal of Offender Therapy and Comparative Criminology 

The Confusion Over Psychopathy 

The Confusion Over Psychopathy (I): 

Historical Considerations 

Bruce A. Arrigo 

Stacey Shipley 

Abstract: This article is the first in a two-part series on psychopathy. Psychopathy is an elusive 

and perplexing psychological construct. Problems posed by this mental disorder are 

linked to changing historical interpretations impacting the current clinical community’s general 

understanding of it, especially in relation to Antisocial Personality Disorder (ASPD). 

Accordingly, the researchers provide a thorough analytical review of the major transitions 

associated with psychopathy’s historical development. This assessment demonstrates where 

and how the nomenclature, meaning, degree of social condemnation, and prognosis for this 

mental disorder have changed. Ultimately, this article clarifies much of the uncertainty surrounding 

this misunderstood psychological construct. 

This article is the first in a two-part series on psychopathy published in the International 

Journal of Offender Therapy and Comparative Criminology. This article 

focuses on the history of psychopathy, mindful of its confusing and complicated 

evolution. The second article addresses the current and practical implications of 

the construct’s development, especially in relation to assessment matters, diagnostics 

and treatment, and expert testimony. 

As an identified mental disorder and evolving label, psychopathy has a long 

history, dating back many centuries. Indeed, researchers have found reference to 

psychopathic individuals in biblical, classical, and medieval texts (e.g., Cleckley, 

1976; Hare, 1996; McCord & McCord, 1964). Notwithstanding its extensive heritage, 

psychopathy has been plagued by changing and uncertain diagnostic 

nomenclature. For example, a great deal of confusion currently exists regarding 

the relationship between Antisocial Personality Disorder (ASPD), as identified 

by the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) 

(DSM–IV), and the modern construct of psychopathy as explained by Cleckley 

(1941) and further refined and empirically validated by Hare (1985, 1991). 

Although contemporary research supporting the diagnosis of psychopathy is at its 

strongest, mental health professionals remain perplexed when diagnosing, treating, 

or making recommendations to the court system about these individuals (e.g., 

Gacono & Hutton, 1994; Hare, 1996; Stevens, 1993). 

Given the ongoing forensic practice problems that ostensibly pervade the psychopathy 

construct, understanding how it has been defined and redefined 

throughout history may be warranted. In general, we note that the psychopathic 

International Journal of Offender Therapy and Comparative Criminology, 45(3), 2001 325-344 

© 2001 Sage Publications 

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326 International Journal of Offender Therapy and Comparative Criminology 

label (i.e., explanation) has changed from the morally neutral view of Pinel 

(1801/1962) to the more truculent and disparaging characterization described by 

Kraepelin (1915). In addition, the designation itself has evolved from the unpopular 

term insanity, to the controversial expression moral, to the present moniker 

psychopathic (Hare, 1996; Millon, Simonsen, & Birket-Smith, 1998). 

The elusiveness of the psychopathic construct and its meaning is further confounded 

by the theoretical basis out of which social scientists approach and investigate 

this mental disorder (Martens, 2000). Indeed, some researchers invoke 

descriptors for psychopathy, implying that the individual experiences morality 

problems that are solely personality based (e.g., Craft, 1966; Dinges, Atlis, & Vincent, 

1998; Millon et al., 1998), exclusively congenitally or biologically derived 

(Ellard, 1988; Schneider, 1958; Smith, 1978), or principally behaviorally 

grounded (American Psychiatric Association, 1994). Moreover, notwithstanding 

these interpretations, Hare’s (1996) empirical and qualitative findings consistently 

demonstrate that the psychopath has distinctive affective, interpersonal, 

and behavioral attributes. 

Relatedly, the clinical construct of psychopathy remains inexplicable and puzzling 

not only in name and definition but also in consequence. In short, neither the 

mental health nor the criminal justice systems have been successful in rehabilitating 

the psychopath. Psychopathic individuals historically and at present are 

almost uniformly considered difficult, if not impossible, to treat. Indeed, as Hare 

(1993) notes, the psychopath is a “self-centered, callous, and remorseless person 

profoundly lacking in empathy and the ability to form warm emotional relationships 

with others, a person who functions without the restraint of a conscience” 

(pp. 2-3). Moreover, the designation carries with it the message that the individual 

is untreatable and cannot be rehabilitated (e.g., Coid, 1998; Ogloff, Wong, & 

Greenwood, 1990; Rice, Harris, & Cormier, 1992). As one researcher concludes, 

psychopaths are “psychiatrically damaged” (Gunn, 1998, p. 34). Given these 

institutional limits and professional practice concerns, establishing any form of 

ongoing, efficacious intervention can, at best, be described as unrealistic and misguided 

(e.g., Meloy, 1996; Rice, 1997; Simon, 1998; Stevens, 1994). 

We submit that the diagnostic confusion surrounding psychopathy (i.e., the 

label and its meaning) and the adverse consequences persons in the mental health 

and criminal justice systems (potentially) experience in the wake of such a determination, 

warrant closer scrutiny. To better appreciate these matters, it is first necessary 

to explore psychopathy’s long and convoluted history, commencing in the 

early 1800s (i.e., the insights of Pinel) and extending to the present day (i.e., the 

contributions of Hare). This historical assessment of psychopathy will illustrate 

the varied philosophical and scientific perspectives expressed by researchers on 

such matters as (a) general nomenclature, (b) form of social condemnation, 

(c) cause of mental illness, and (d) amenability to treatment. 

Although clearly not exhaustive, this overview will provide an important backdrop, 

making it possible to assess provisionally how psychopathy evolved into a 

mental disorder and a pejorative label. In addition, the development of the con-

The Confusion Over Psychopathy 327 

struct as a DSM diagnosis will be examined. In particular, we will consider the 

logic of linking psychopathy, as applied to forensic clients, with the behavioral 

diagnosis of ASPD. Ultimately, this degree of historical analysis sheds much 

needed light on the changing and misunderstood nature of the psychopathy 

construct. 

HISTORICAL CONTEXT OF PSYCHOPATHY: A REVIEW 

Table 1 summarizes the progression of thought regarding the construct of psychopathy 

from the early 1800s to the late 1900s. 1 We note that Table 1 identifies 13 

transitions impacting our general understanding of this mental disorder. Each 

transition addresses several important components of psychopathy’s’s evolution: 

(a) the approximate date of change, (b) the theorist most responsible for the 

change, (c) the nomenclature employed, (d) the description of the disorder, (e) the 

type/degree of social condemnation, and (f) the perceived prognosis/treatment. 

We recognize that the 13 transitions are more overlapping than independent 

frames of references; therefore, they should not be interpreted as isolated or exclusive 

domains of inquiry. This notwithstanding, the progression of thought contained 

within each of the components or categories demonstrates the course of 

psychopathy’s development and demonstrates how each has ostensibly functioned 

along a continuum (e.g., social condemnation as morally neutral to morally 

reprehensible, the disorder’s description based on personality to behavioral traits, 

and the locus of treatment from asylums to prisons). In the following sections, we 

briefly examine each of these transitions and the unique positions each assumes in 

relation to the various categories. 

PINEL 

As previously stated, the psychopathy construct has a long history with changing 

personality patterns and clinical characteristics, dating back through the past 

two centuries (Millon et al., 1998). Phillipe Pinel is generally credited with recognizing 

psychopathy as a specific mental disorder (Smith, 1978). Pinel advocated 

for appropriate, moral treatment rather than cruel interventions (e.g., bloodletting, 

cold baths) as the preferred method of intervention for the psychiatrically ill 

(Pinel, 1801/1962). Pinel’s contributions occurred in France shortly after the 

French Revolution. Prior to this time, France was ruled by a strict class structure 

and sanity was judged by the Old Testament of the Bible (Smith, 1978). 

In 1801, Pinel observed that some of his patients engaged in impulsive acts, 

had episodes of extreme violence, and caused self-harm (Davies & Feldman, 

1981; Millon et al., 1998). He noted that these individuals were able to comprehend 

the irrationality of what they were doing. There was no evidence of what is 

now considered psychosis, and their reasoning abilities did not appear to be 

impaired. He described these men as suffering from manie sans délire (insanity

328 

TABLE 1 

THE HISTORICAL CONTEXT OF PSYCHOPATHY 

Date Theorist Source Nomenclature Describe Social Condemnation Perceived Prognosis/tx 

1801 Pinel manie sans délire insanity w/o delirium morally neutral moral tx; no bleeding 

1812 Rush moral alienation total perversion of moral enter social condemnation tx preferred in medical settings 

of the mind faculties 

1835 Prichard moral insanity deplorable defect in personality social castigation intensifies no volitional control: should be 

legal defense 

1891 Koch psychopathic strictly congenital personality attempts to shed social depends on the type: chronic or 

inferiority types condemnation temporary 

1897 Maudsley moral imbecility criminal class affected by criminal class status useless to punish those that 

cerebral deficits cannot control their behavior 

1904 Krafft-Ebing morally depraved savages in society severe condemnation without prospect of success— 

asylums indefinitely 

1915 Kraepelin psychopathic most vicious/wicked: born moral judgement/social poor 

personalities criminal, liars, swindlers . . . condemnation 

1941 Cleckley psychopath detached/narcissistic pejorative poor 

interpersonal style

329 

1952 APA’s DSM Sociopathic more social perspective; pejorative poor 

Personality Cleckley’s features and 

Disturbance; some criminal behaviors 

antisocial/dyssocial 

sociopath 

1968 DSM-II ASPD still focused on the personality pejorative poor 

dropped dyssocial traits of the psychopath 

sociopath; only 

antisocial remained 

1980/ DSM-III; ASPD chronic violation of social pejorative; includes most typically poor, but symptoms 

1987 DSM-III-R norms: Conduct Disorder offenders diminish with age 

1985/ Hare’s PCL/ Psychopathy 2 Factor Model; reliable and pejorative poor; can become worse 

1991 PCL-R valid with tx 

1994 DSM-IV ASPD focused on behavioral criteria pejorative equated with poor, but symptoms diminish 

criminal with age 

NOTE: APA = American Psychiatric Association; DSM = Diagnostic and Statistical Manual of Mental Disorders; ASPD = Antisocial Personality Disorder; PCL = Psychopathy 

Checklist; PCL-R = Psychopathy Checklist–Revised; tx = treatment.


without delirium) (Dinges et al., 1998; Millon et al., 1998). As Pinel (1801/1962) 

explained, “I was not a little surprised to find many maniacs who at no period gave 

evidence of any lesion of understanding, but who were under the dominion of 

instinctive and abstract fury, as if the faculties of affect alone had sustained injury” 

(p. 9). His observations were very controversial during this era, especially 

because a low intellect and symptoms of psychosis were the typical criteria for 

identifying mental illness (Stevens, 1993). 

RUSH 

In the early 1800s, Benjamin Rush, an American psychiatrist, also documented 

confusing cases that were described by clarity of thought along with 

moral depravity in behavior (Millon et al., 1998). However, Rush (1812) went 

beyond Pinel’s more affectively based description and maintained that moral 

derangement was either a birth defect or was caused by disease. Rush believed this 

condition was primarily congenital. As he stated, “There is probably an original 

defective organization in those parts of the body which are preoccupied by the 

moral faculties of the mind” (p. 112). In addition, Rush held that “it is the business 

of medicine to aid both religion and law, in preventing and curing their moral 

alienation of the mind” (p. 359). The American psychiatrist maintained that the 

lack of morality was primarily hereditary, yet unstable environments were largely 

responsible for fostering its growth (Smith, 1978). Rush further claimed that 

offenders with mental defects were best treated in medical rather than custodial 

institutions (Toch, 1998). 

Benjamin Rush is recognized as one of the first to begin what has since become 

a long-standing practice of social condemnation toward individuals labeled psychopathic. 

However, his classification of persons as morally alienated in the mind 

did not go without criticism. The essence of the criticism was that his clinical 

assessment for psychopathy was too generic a diagnosis and was overly inclusive. 

As John Adams commented, 

Rush is so near to my heart, that I must return to his very interesting Volume. It 

seems to me, that every excess of Passion, Prejudice, Appetite; of Love, Fear, Jealousy, 

Envy, Revenge, Avarice, Ambition; every Revery and Vagary of Imagination, 

the Fairy Tales, the Arabian Nights, in short, almost all Poetry and all Oratory; every 

écart, every deviation from pure, logical mathematical Reason; may in Some Sense 

be called a disease of the mind. (quoted in Ellard, 1988, pp. 384-385) 

PRICHARD 

J. C. Prichard (1835) was a British physician and the first to actually coin the 

expression moral insanity. Prichard defined moral insanity as “a morbid perversion 

of the natural feelings, affections, inclinations, temper, habits, moral dispositions, 

and natural impulses, without any remarkable disorder or defect of the


intellect or knowing and reasoning faculties, and particularly without any insane 

illusion or hallucination” (1837/1973, p. 16). Prichard agreed with many aspects 

of Pinel’s findings; however, he fervently disagreed with Pinel’s “morally neutral” 

position toward such individuals (Millon et al., 1998, p. 5). In fact, Prichard 

argued that the morally insane exhibited a deplorable defect in personality that 

constituted social castigation (p. 5). He postulated that those afflicted knew the 

difference between right and wrong but were compelled to engage in reprehensible 

behaviors. As Prichard (1835) observed, 

There is a form of mental derangement in which the intellectual functions appear to 

have sustained little or no injury, while the disorder is manifested principally or 

alone in the state of the feelings, temper or habits. In cases of this nature the moral or 

active principles of the mind are strangely perverted or depraved; the power of 

self-government is lost or greatly impaired and the individual is found to be incapable, 

not of talking or reasoning upon any subject proposed to him, but of conducting 

himself with decency and propriety in the business of life. (p. 85) 

Critics of Prichard’s observations contend that his moral insanity category was 

so broad that it encompassed other mental disorders recognized as such today 

(e.g., Toch, 1998). This notwithstanding, others note that Prichard’s contributions 

added to the clinical perception of what constituted a mental disorder (Millon 

et al., 1998). Investigators generally agree, however, that the antisocial or dangerous 

acts committed by these individuals were not the cause of the mentally ill designation. 

Rather, the overwhelming and irresistible impulses that functioned outside 

the person’s control led to the moral insanity classification. Thus, it follows 

that moral insanity reduced criminal culpability. Indeed, according to Prichard, 

moral insanity should be employed as a legal defense (Toch, 1998). 

KOCH 

The appropriate designation for what is today known as psychopathy underwent 

several changes and iterations. For example, a number of German theorists 

described a series of trait syndromes for the psychopath (Craft, 1966). In 1891, 

Koch used the term psychopathic inferiority to characterize individuals who 

engaged in abnormal behaviors due to heredity but who were not insane. They 

were determined to have moral defects, but these defects were not equated with 

viciousness or wickedness (Ellard, 1988). This new terminology (i.e., psychopathic 

inferiority) described emotional and moral aberration based on congenital 

factors and found wide acceptance in Europe and America (Smith, 1978). 

In part, because of Koch’s findings, clinical and forensic assessment efforts 

have recognized, until more recently, that psychopathic inferiority broadly represents 

all personality disorders (Millon et al., 1998). Koch’s work was an attempt 

to identify personality types. He divided his congenital psychopathic inferiorities 

into three groups: (a) psychopathic disposition—psychic tenderness in an 

asthenic individual; (b) psychic inferiority—vulnerable types (sensitive and


weak), vigorous types (grandiose, troublemaker), and the intermediate types 

(blunted nature); and (c) psychopathic degeneration—intellectual and moral failure 

caused by cerebral defects (Schneider, 1958, pp. 20-21). 

Koch sought to displace much of the social condemnation underscoring 

Prichard’s concept of moral insanity (Schneider, 1958). In addition, he attempted 

to recast psychopathic inferiority as strictly a congenital disorder. This initiative 

was thwarted, however, when the more social perspective of sociopathy emerged 

(Ellard, 1988). Despite Koch’s attempts to deviate from what had been considered 

moral insanity, the more current conceptualizations of psychopathy still reflect its 

derogatory character (Millon et al., 1998). In other words, following Koch, during 

the first several years of the 20th century, psychopathy signified nothing more 

than abnormality in behavior that was congenital in nature (Schneider, 1958, p. 21). 

However, notwithstanding Koch’s efforts, the meaning of psychopathy in subsequent 

years once again became something quite pejorative but also something 

more reflective of the internal world and personality traits of the individual. 

MAUDSLEY 

Maudsley (1897/1977) was a British psychiatrist who asserted that persons 

prone to moral imbecility could not be rehabilitated in prisons. He believed that a 

distinct class of offenders was “marked by a defective physical and mental organization 

determin[ing] their destiny ...[and creating] an extreme deficiency or 

complete absence of moral sense” (quoted in Toch, 1998, p. 146). Maudsley 

argued that moral imbecility was caused by cerebral deficits. As such, he believed 

it was useless to punish those who could not control their actions. He identified a 

criminal class; namely, “chronic offenders of lower-class origin” (Toch, 1998, p. 

147), and wrote the following as evidence of moral imbecility: 

When we find young children, long before they can possibly know what vice and 

crime means, addicted to extreme vice, or committing great crimes, with an instinctive 

facility, and as if from an inherent proneness to criminal actions...andwhen 

experience proves that punishment has no reformatory effect upon them—that they 

cannot reform—it is made evident that moral imbecility is a fact, and that punishment 

is not the fittest treatment of it. (quoted in Toch, 1998, p. 147) 

KRAFFT-EBING 

Krafft-Ebing (1904) was even less sympathetic toward those considered morally 

depraved than was Benjamin Rush. The former was among the first to assert 

that such individuals were “without prospect of success” and commented that 

“these savages...must be kept in asylums for their own [good] and [for] the safety 

of society” (quoted in Toch, 1998, p. 148). It was at this historical juncture that 

psychopathic individuals were regarded as impervious to rehabilitation and that 

chronic social deviance was equated with pathology (Ellard, 1988).


Krafft-Ebing is also credited with discovering several other important and 

enduring psychological constructs that present critical implications for the most 

violent of psychopaths. For example, he introduced the terms sadism and masochism 

into the assessment lexicon (Millon et al., 1998). These terms were derived 

from the short stories and other works by Marquis de Sade, a French nobleman 

and writer who lived during the 18th century (Millon et al., 1998) The Marquis’ 

stories described the intentional infliction of pain and sexual domination (i.e., 

sadism) as well as the pleasure and sexual gratification or both of being humiliated 

or suffering bodily harm (i.e., masochism). Krafft-Ebing claimed that all humans 

have an “innate desire to humiliate or hurt” and that “sexual emotion, if 

hyperesthetic, might degenerate into a craving to inflict pain” (quoted in Millon 

et al., 1998, p. 9). Aggression was considered a normal element of the male sex 

drive, which, if exaggerated, could lead to sadism (Millon et al., 1998). 

Krafft-Ebing found that sadism in a psychopath was particularly alarming 

because those subjected to this mental illness were much more likely to act on 

their dangerous impulses. 

KRAEPELIN 

The approach to the disorder of psychopathy derived principally from somatic 

descriptors evolved from German theorists who explained it by utilizing massive 

typological systems (Craft, 1966). By 1915, Kraepelin expanded Koch’s psychopathic 

inferiority terminology to contain categories essentially defined by the 

most vicious and wicked of disordered offenders (Ellard, 1988). Prior to 

Kraepelin, the categories of psychopathies contained various personality descriptions. 

Kraepelin, however, wanted to narrow the classification to only those characteristics 

that were the most devastating and most frequently detected by physicians 

working in institutions. His psychopathic personalities described in detail 

the “born criminal . . . the excitable, shiftless, impulsive types, the liars, swindlers, 

antisocial and troublemaking types” (Schneider, 1958, p. 23). Kraepelin portrayed 

“morbid liars and swindlers” as manipulative, glib, charming, and unconcerned 

for others (Millon et al., 1998, p. 19). Another category designated by 

Kraepelin included criminals by impulse, who were overcome by uncontrollable 

desires to commit offenses like arson or rape for purposes unrelated to material 

gain. A third classification included professional criminals, who acted out of cold, 

calculated self-interest rather than from uncontrollable impulse. Finally, a fourth 

type consisted of morbid vagabonds, who wandered through life with neither 

self-confidence nor responsibility (Millon et al., 1998). 

Clearly with these characterizations, Kraepelin moved the focus of psychopathy 

back to one of moral judgment and social condemnation. Interestingly, as 

Millon et al. (1998, p. 19) note, his categories of psychopathic personalities more 

closely represent our conceptualization of psychopathy and ASPD today. This 

association is found in Kraepelin’s statements on the classification of antisocial 

personalities. He described these disordered individuals as


the enemies of society...characterized by a blunting of the moral elements. They 

are often destructive and threatening . . . there is a lack of deep emotional reaction; 

and of sympathy and affection they have little. They are apt to have been troublesome 

in school, given to truancy and running away. Early thievery is common 

among them and they commit crimes of various kinds. (quoted in Millon et al., 1998, 

p. 10) 

CLECKLEY 

The publication of Cleckley’s text, The Mask of Sanity (1941), marked the 

beginning of the modern clinical construct of psychopathy, and his characterization 

has remained relatively stable to the present day (Hart & Hare, 1997). 

Cleckley based his description of the psychopath on observations of White, 

middle-class male patients, residing as inpatients of a mental hospital (Dinges 

et al., 1998). He acknowledged the confusion caused by the changing psychopathic 

nomenclature and the overly inclusive descriptions of past investigators. 

Hart and Hare (1997) summarized the essential features of Cleckley’s psychopath 

as follows: 

Interpersonally, psychopaths are grandiose, arrogant, callous, superficial, and 

manipulative; affectively, they are short-tempered, unable to form strong emotional 

bonds with others, and lacking in empathy, guilt or remorse; and behaviorally, they 

are irresponsible, impulsive, and prone to violate social and legal norms and expectations. 

(pp. 22-23) 

According to Lykken (1995), Cleckley viewed moral feelings or the human 

conscience as learned, and the learning process was directed and reinforced by 

emotional feelings. In addition, Cleckley contended that if normal human emotions 

were diminished, the development of morality or socialization would be 

jeopardized. Ultimately, he found that normally socializing experiences were ineffectual 

with psychopaths. The conceptualization of the psychopath by Cleckley 

focused on the patient’s intrapersonal characteristics or “inferred, nonobservable, 

processes . . . such as lack of judgment, impulsivity, an inability to feel remorse or 

guilt, an inability to learn from punishment, and rationalizing or blaming others 

for one’s behavior” (Dinges et al., 1998, p. 463). Clearly, then, the focus was not 

on their criminal history. 

Indeed, Cleckley (1941) recognized that many psychopaths never became 

involved with the criminal justice system. Moreover, many could succeed in business 

or in other endeavors, particularly in those careers that offered considerable 

material success. Commenting on the differences between the nonoffending psychopaths 

and their criminal counterparts, Cleckley noted that 

a very deep seated disorder often exists. The true difference between them and the 

psychopaths who continually go to jails or psychiatric hospitals is that they [i.e., the 

nonoffenders] keep up a far better and more consistent outward appearance of being 

normal. (pp. 198-199)


Following these observations, Cleckley (1941) observed that the primary psychopathic 

characteristics of glibness, superficial charm, emotional detachment, 

and lack of remorse or guilt could be used for successful criminal or noncriminal 

careers. Psychopaths can pursue what they want without experiencing anxiety attributable 

to a concern for how their actions might impact others. In the long run, 

Cleckley argued that the impulsive conduct of psychopaths would frequently be 

detrimental to them. In addition, the inability to plan for the future or learn from 

consequences were other traits inherent to his interpretation of the psychopathic 

personality. Cleckley also described the psychopath’s behavior. As he 

commented, 

It is impossible for him to take even the slightest interest in the tragedy or joy or the 

striving of humanity as presented in serious literature or art. He is also indifferent to 

all these matters in life itself. Beauty and ugliness, except in a very superficial sense, 

goodness, evil, love, horror, and humor have no actual meaning, no power to move 

him. (p. 90) 

Cleckley (1941) also said that the psychopath 

is lacking in the ability to see that others are moved. It is as though he were 

color-blind, despite his sharp intelligence, to this aspect of human existence. It cannot 

be explained to him because there is nothing in his orbit of awareness that can 

bridge the gap with comparison. He can repeat the words and say glibly that he 

understands, and there is no way for him to realize that he does not understand. 

(p. 90) 

Cleckley’s research on psychopathy and his subsequent classification of its essential 

traits reflected a distinct psychiatric category (Ellard, 1988). His conceptualization 

of the psychopath identified the impact of heredity on crucial learned behaviors; 

that is, a developed human conscience. For example, the psychopath 

would be unable to experience the emotions necessary to reinforce moral behavior. 

In addition, the psychopath would not experience the typical anxiety that 

would cause someone to fear behaving in a socially inappropriate manner. 

Evidence concerning the impact of heredity and other supporting data about 

this category were presented to the Royal Commission on the Law Relating to 

Mental Illness and Mental Deficiency 1954-1957 (Ellard, 1988; Lykken, 1995). 

In the wake of Cleckley’s (1941) findings, the word psychopath became popular 

among laypersons as well as mental health professionals. Ellard (1988) attributes 

this notoriety to the term’s status as both an explanation for and a cause of 

depraved and frequent criminal behavior. He cautions, however, that this logic 

was as inherently circular and suspect during Cleckley’s period as it is today. 

Illustrating the tautological nature of Cleckley’s psychopath, Ellard questions, 

“Why has this man done these terrible things? Because he is a psychopath. And 

how do you know that he is a psychopath? Because he has done these terrible 

things” (p. 387).


THE DIAGNOSTIC AND STATISTICAL MANUAL 

OF MENTAL DISORDERS (DSM) 

The first publication of the American Psychiatric Association’s (1952) DSM 

renamed the evolving psychopathic construct Sociopathic Personality Disturbance 

(Millon et al., 1998). This change demonstrated the fusion of previous psychiatric 

explanations with more socially sensitive interpretations. Researchers, 

too, began to support this more integrative position. As McCord and McCord 

(1964) explained, “In addition to the individual causative factors, consideration 

should be given to the cultural factors that may contribute to psychopathy” (p. 87). 

Investigators hoped that this psychosocial emphasis would clarify how the individual 

was also a part of a group and not just an isolated subject experiencing 

internal perversions (Smith, 1978). Interestingly, however, the original DSM criteria 

for Sociopathic Personality Disturbance included many of the personality 

characteristics set forth by Cleckley (1941) in his description of the psychopath. 

The focus on internal processes and personality traits would give way to more 

behavioral criteria in later DSM editions. 

The scientific push to explain how actions were determined externally is attributable 

to the large behaviorist movement that occurred in the United States during 

the mid-20th century. Smith (1978) discussed the social trespass theory that was 

prevalent during this period. The theory states that specific cultures are responsible 

for judging certain behaviors deviant. In other words, actions are considered 

abnormal if, and only if, they violate the social and legal boundaries of the group 

to which they belong. This focus on deviant behavior was criticized by some 

because all classes of criminals (e.g., thieves, sex offenders) were pushed into the 

same category (i.e., Sociopathic Personality Disorder) (McCord & McCord, 

1964). In effect, the focus shifted from the abnormal internal processes of the psychopath 

to include generic and overly inclusive deviant behaviors of many types 

of (offending) individuals. 

These concerns notwithstanding, the DSM retained personality traits such as a 

lack of guilt, anxiety, or a sense of responsibility as a part of the diagnostic criteria. 

The diagnosis had no requirement for the presence of childhood symptoms (APA, 

1952). Another distinction for this diagnosis was the existence of antisocial and 

dyssocial sociopaths. The dyssocial sociopath was identified as a professional 

criminal who could be extremely loyal to his comrades (e.g., members of organized 

crime) (Smith, 1978). 

DSM-II 

The dyssocial sociopath distinction was eliminated with the publication of the 

DSM-II (APA, 1968). Smith (1978) contended that the extreme loyalty to family 

and friends made this classification represent no other pathology except illegal 

behaviors. The personality characteristics of the psychopath were not conveyed in 

the dyssocial sociopath. The antisocial classification that remained still focused


on the psychopath’s personality traits. For example, the DSM-II described this 

type of individual as callous, impulsive, selfish, and unable to learn from experience 

(APA, 1968). However, some critics maintained that the DSM-II did not provide 

specific diagnostic criteria for the disorder (Hare, 1996). 

DSM-III and DSM-III-R 

The issue of explicit diagnostic criteria was solved with the publication of the 

DSM-III (1980) and the DSM-III-R (1987). Following both manuals, the diagnosis 

for psychopathy was called Antisocial Personality Disorder (ASPD); however, 

it no longer focused on personality traits. The criteria were changed by emphasizing 

behaviors. The DSM-III Task Force felt that the clinical inferences necessary 

to determine the personality characteristics of a psychopath lowered the reliability 

of the diagnosis. Therefore, a diagnostic shift to behavioral characteristics 

commonly associated with the disorder was considered more reliable for identification 

purposes than were the personality factors explaining why the behaviors 

occurred (Hare, 1996). However, the new criteria were so broad they included 

almost every known criminal offense (Stevens, 1993). 

This new formulation of ASPD included Conduct Disorder or a history of deviant 

behavior before the age of 15 as a necessary element to reach the diagnosis. 

This diagnostic criterion is met by finding 3 of 12 types of deviant behaviors 

including, among others, lying, truancy, physical cruelty to animals or people, 

arson, and fighting (APA, 1987). However, some critics note that this criterion can 

also be a self-fulfilling prophecy (e.g., Millon et al., 1998). Indeed, some children 

may engage in antisocial behavior as a protective function, rather than a biologically 

based psychopathic personality (Lykken, 1995; Widom, 1998). 

Examining the presence of antisocial behavior in adolescents, Widom (1998) 

explains that abuse or neglect encourages the development of childhood coping 

styles that, although adaptive in an dysfunctional home, would not be adaptive as 

an adult in other relationships. The youth might develop characteristics such as a 

lack of realistic long-term goals, manipulation, pathological lying, or superficial 

charm to cope in his or her abusive home. Robins (1978) articulating this view, 

explained the process through a behavioral sequence of events: 

The very fact of deviance beginning early in childhood makes a succession of interconnected 

problems highly probable. Early truancy leads to leaving school before 

graduation, which in turn creates job problems, which then encourages theft, which 

leads to jail ...wearetalking about the consequences of severe antisocial behavior 

occurring early in childhood. (pp. 269-270) 

For the ASPD diagnosis, at least 4 of 10 behavioral categories must be met. These 

categories include such things as “inability to sustain consistent work behavior...fails 

to conform to social norms with respect to lawful behavior ...isirritable 

and aggressive, as indicated by physical fights or assaults” (APA, 1980,


p. 345). Other behavioral categories include lying, impulsive conduct, inability to 

establish lasting, stable relationships, and a disregard for personal safety (APA, 

1987; Stevens, 1993). 

At least one member of the DSM-III Task Force was not convinced that this 

new diagnosis appropriately represented the psychopathy construct it was 

designed to identify and measure. Millon (1981) wrote of his dissatisfaction with 

the Task Force’s diagnosis of ASPD, alleging that “the write-up fails to deal with 

personality characteristics at all, but rather lists a series of antisocial behaviors 

that stem from such characteristics”(p. 182). In addition, he explained that too 

great an emphasis was placed on delinquent and criminal behaviors for the diagnosis. 

Millon also cited instances where some individuals with similar psychopathic 

personalities will express these characteristics in socially appropriate 

ways. In other words, he argued that the ASPD diagnosis was overly inclusive. 

Following Millon’s (1981) criticisms, not everyone who engages in criminal 

behavior experiences an absence of anxiety, guilt, or has shallow emotions. Furthermore, 

some psychopaths do not fit under the ASPD diagnosis, given the heavy 

emphasis on illicit conduct in adolescence and adulthood. Indeed, consistent with 

Millon’s observations, some researchers conclude that the newest nomenclature 

for psychopathy (i.e., ASPD) sacrifices validity for the sake of reliability (Hare, 

1998). 

Rogers, Dion, and Lynett (1992) criticized the DSM-III and DSM-III-R criteria 

for the ASPD diagnosis because of its polythetic model. These investigators contend 

that the minimum criteria requirement for this diagnosis is based on two inaccurate 

premises: (a) The criteria are not weighted; that is, no one criterion is more 

significant for a diagnosis than another; and (b) the frequency or severity of symptoms 

has no significance with regard to the diagnosis. In addition, Hart and Hare 

(1997) contended that “there is little systematic experimental evidence to support 

the validity of the DSM criteria” (p. 25). 

DSM-IV (1994) 

The objections leveled against the DSM determination of ASPD resulted in 

slight changes in the DSM-IV diagnosis. According to the DSM-IV (APA, 1994), 

ASPD “has also been referred to as psychopathy, sociopathy, or dyssocial personality 

disorder” (p. 645). Hare (1998) suggested that although this inclusion makes 

it easier for forensic psychologists or psychiatrists to discuss psychopathy in their 

evaluations or court testimony, greater confusion exists regarding the association 

between ASPD and psychopathy. Indeed, although the DSM-IV diagnosis retains 

the emphasis on antisocial behavior, many individuals diagnosed may not be 

psychopathic. 

In addition, the DSM-IV (1994) states that “a lack of empathy, inflated 

self-appraisal, and superficial charm are features that have commonly been 

included in the traditional conceptions of psychopathy, and may be particularly 

distinguishing of Antisocial Personality Disorder in prison or in forensic settings


where criminal, delinquent, or aggressive acts are likely to be nonspecific” 

(p. 647). Hare (1998) concluded that an informal dichotomy of the ASPD criteria 

has been created for the community and for forensic environments, leaving the 

individual clinician to assess for psychopathic traits on his or her own. If a 

DSM-IV diagnosis is required, perhaps a diagnosis of severe ASPD with psychopathic 

traits should be indicated for psychopathic individuals. A more detailed 

discussion of diagnostic possibilities is provided in subsequent sections. For now, 

however, we note that changes in the DSM-IV diagnosis of psychopathy present 

researchers and (forensic) practitioners with additional and perplexing diagnostic 

problems related to ASPD. 

HARE’S PSYCHOPATHY CHECKLIST–REVISED 

Some critics of the psychopathy construct contend that a pure conceptualization 

of it is absent in the ASPD diagnosis, and that it is too behaviorally based, to 

the neglect of persistent personality traits (Hart & Hare, 1993, 1997). Hare (1998) 

maintained that this construct drift is the result of achieving good reliability with 

the ASPD diagnosis but limited validity (p. 190). Arguably, the significant reliance 

on behavioral criteria does not accurately measure psychopathy. This particular 

objection prompted Hare (1980) to develop his Psychopathy Checklist 

(PCL), followed by a more revised version; namely, the PCL-R (Gacono, 1998; 

Gacono & Hutton, 1994; Hare, 1985, 1991; Hart & Hare, 1997). Both the PCL and 

the PCL-R attempt to operationalize the concept of psychopathy based on the primary 

features of Cleckley’s (1941) original criteria. The PCL-R is a more quantifiable 

and semistructured interview with good reliability, validity, and norms 

(Hare, 1991). 

Hare went beyond describing the psychopath to creating a reliable and valid 

way to assess for psychopathy. Validity data on the PCL-R were collected from 

1978 to 1991 before the revised instrument was published (Hare, 2000). It was 

validated for male adults in forensic settings and validation studies for female 

adults are still in progress (Forth, 2000; Hare, 1991). In addition, global ratings of 

the disorder were created based on clinical observations (Hare, 1998). 

The PCL-R is a 20-item instrument that is on a 0-to-40-point scale (Hare, 1991; 

Hart & Hare, 1993). A cutoff of 30 is used for research purposes and, due to the 

standard error of measurement, a cutoff of 33 is suggested for clinical practice to 

reduce the chance of making diagnostic mistakes, particularly with forensic clients 

(Hare, 1991). The PCL-R approaches psychopathy from a two-factor perspective. 

All but 3 of the 20 items load on one of the two factors. 

Factor 1 represents interactional/emotional style and has been described as 

aggressive narcissism (Meloy, 1988). Items that load on Factor 1 are more indicative 

of personality traits, including, among others, (1) glibness and superficial 

charm, (2) grandiose sense of self-worth, (4) pathological lying, (5) conning/ 

manipulative, (6) lack of remorse, (7) shallow affect, (8) callous lack of empathy, 

and (16) failure to accept responsibility for one’s own actions (Hare, 1991).


Factor 2 items address behaviors or behavioral styles common to psychopaths, 

including, among others, (3) proneness to boredom, (9) parasitic lifestyle, (10) 

poor behavioral controls, (12) early behavioral problems, (13) lack of realistic 

long-term goals, (14) impulsivity, (15) irresponsibility, (18) juvenile delinquency, 

(19) revocation of conditional release (Hare, 1991). Whereas Factor 1 items 

remain relatively stable over time, Factor 2 items can diminish with age (Hare, 

1996). Additionally, in Hare (1996), only Factor 2 items have any correlation with 

the DSM-IV’s ASPD diagnosis. 

Both interviews with the participant and collateral data are recommended for 

the most accurate assessment. However, some researchers have used collateral 

data only (e.g., Harris, Rice, & Quinsey, 1991). This approach limits the evaluator’s 

ability to assess for glibness and superficial charm as well as many other Factor 

1 personality traits (Hare, 2000). In addition, collateral data is mandatory for a 

valid assessment of psychopathy (Hare, 1991). The instrument uses a 3-point rating 

scale (0, 1, 2) for each item that is based on observation of interactional style, 

assessing consistency of lifestyle, personality traits, and behavior, and historical 

information (Forth, 2000; Hare, 1991). The interview covers education, employment, 

family, interpersonal relationships, and both adolescent and antisocial 

behaviors. The interview portion of the assessment can range from approximately 

90 to 120 minutes. Additionally, reviewing the collateral data can take anywhere 

from 20 minutes to 2 to 3 hours (Forth, 2000; Hare, 1991). Whereas the DSM-IV 

includes the ASPD diagnosis, PCL-R scores are used to determine specifically 

whether an individual is psychopathic. 

Interestingly, many of the items that make up the PCL-R can be identified in 

Prichard’s (1873/1973) description of the morally insane. As Prichard commented, 

The individual follows the bent of his inclinations; he is continually engaging in new 

pursuits, and soon relinquishing them without any other inducement than mere 

caprice and fickleness. At length the total perversion of his affections, the dislike, 

and perhaps even enmity, manifested toward his dearest friends, excite greater 

alarm. . . . Persons labouring under this disorder are capable of reasoning or supporting 

an argument upon any subject within their sphere of knowledge that may be presented 

to them; and they often display great ingenuity in giving reasons for the 

eccentricities of their conduct, and in accounting for and justifying the state of moral 

feeling under which they appear to exist. (p. 21) 

We note that Item 3 (need for stimulation/proneness to boredom), Item 4 

(pathological lying), Item 5 (conning/manipulative), Item 8 (callous/lack of empathy), 

Item 10 (poor behavioral controls), Item 13 (lack of realistic long-term 

goals), Item 14 (impulsivity), and Item 15 (irresponsibility) can all be inferred 

from the observations of Prichard.


CONCLUSION 

This article traced the development of psychopathy from its historical context 

to its modern-day (mis)use. An analytical review of the literature demonstrated 

the moral, personality, and social deviance components of the disorder. To help 

clarify much of the diagnostic confusion surrounding this construct, the 

ASPD/psychopathy continuum was discussed. 

From its earliest conception to its present-day manifestation, psychopathy has 

spawned enormous debate. The controversy has encompassed such wide-ranging 

concerns as the morality of the individual and whether the psychopath’s actions 

are volitional. One of the most strongly contested elements of the diagnosis is 

whether these mentally disordered individuals should be socially condemned. 

Although it appears that psychopathy has remained, more or less, a pejorative 

label, the most recent debate entails the use of more behavioral criteria rather than 

personality traits to diagnose effectively the psychiatric illness. Notwithstanding 

its evolution, two features of this mental disorder have remained relatively stable 

and constant. First, strong reality contact or the lack of psychosis is an essential 

criterion for the existence of psychopathy. Second, psychopathic individuals, 

overall, are considered untreatable. As such, some researchers have debated the 

fate of psychopaths in asylums or prisons, but most agree their dispositions are 

largely unchangeable. 

Given the foregoing historical analysis, it remains to be seen what the range of 

present-day correctional and psychological practice implications are for psychopaths. 

Evaluation, diagnosis/treatment, and courtroom testimony issues are particularly 

worth noting. These matters require greater research attention and explanation. 

This is the focus of the second article in our two-part series on the 

confusion over psychopathy. 

NOTE 

1. Although missing from the historical analysis, it is worth mentioning a few contributions developed 

by the Italian physician Cesare Lombroso (1835–1909). Lombroso was interested in how certain 

“inferior” physical characteristics detected in people (e.g., asymmetry of the face, large jaw and 

cheekbones, deviations in head size and shape) could be traced to criminals (Lombroso, 1889). Moreover, 

in his later theoretical reformulations, Lombroso extended his insights beyond physiological and 

anthropological determinants of crime causation. His typology of born criminals, insane criminals, 

and criminaloids is particularly useful for understanding the psychopath. Although he did not 

expressly describe this psychological condition, he did identify criminaloids as individuals “whose 

mental and emotional makeup was such that under certain circumstances they indulge[d] in vicious 

and criminal behavior” (Vold, Bernard, & Snipes, 1998, p. 34). Lombroso’s insights, although in some 

ways indirectly felt, were to have an impact on subsequent studies interpreting criminal behavior, 

including psychopathy.


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Bruce A. Arrigo, Ph.D. 

Professor and Chair 

Criminal Justice Department 

University of North Carolina–Charlotte 

9201 University City Boulevard 

Charlotte, NC 28223 

USA 

Stacey Shipley, M.A. 

Milwaukee County Mental Health Complex 

Milwaukee, WI 53204 

USA

The Confusion Over Psychopathy (I): Historical Considerations

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