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  • 1. THE MAKING OF A PSYCHOPATH MILEN SANTIAGO RAMOS MA, MSc, PhD
  • 2. ANTISOCIAL
    • Antisocial personality disorder is a condition in which people show a pervasive disregard for the law and the rights of others. People with antisocial personality disorder may tend to lie or steal and often fail to fulfill job or parenting responsibilities. The terms "sociopath" and "psychopath" are sometimes used to describe a person with antisocial personality disorder.
    • Antisocial personality disorder is a chronic condition and represents one of the most difficult personality disorders to treat. However, psychotherapy and some medications may help alleviate symptoms. In many cases, the symptoms of antisocial personality disorder decrease as the person reaches middle age.
    • Antisocial personality disorder is characterized by a lack of regard for the moral or legal standards in the local culture. There is a marked inability to get along with others or abide by societal rules. Individuals with this disorder are sometimes called psychopaths or sociopaths.
  • 3. Antisocial
    • Millon and others have argued that the DSM only provides a checklist of "bad boy" behaviors, and skips over the inner workings of the disorder. Thus, the diagnostic criteria are very behaviorally based and it is possible to over-diagnose this disorder. The prevalence is about 3% of the general population for men, 1% for women.
    • Antisocial Personality Style and Antisocial Personality Disorder. People with this Style show some of the characteristics. People with the Disorder show more or all of them, and show them in a more severe form.
    • Example: Think of the computer geek who writes viruses to destroy people's computer files and systems for the feeling of power, who argues no "thing" is destroyed so it isn't a crime, and rationalizes that by doing this is he doing the world a "favor" by exposing vulnerable computer system flaws .
  • 4. Symptoms
    • The classic person with an antisocial personality is indifferent to the needs of others and may manipulate through deceit or intimidation. . They are usually loners.
    • People with antisocial personality disorder can be aggressive and violent and are likely to have frequent encounters with the law. However, some antisocial personalities may also possess a considerable amount of charm and wit.
    • Common characteristics of people with antisocial personality disorder include :
      • Persistent lying or stealing
      • Recurring difficulties with the law
      • Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
      • Aggressive, often violent behavior; prone to getting involved in fights
      • Inability to keep a job
  • 5.
      • A persistent agitated or depressed feeling (dysphoria)
      • Inability to tolerate boredom
      • Disregard for the safety of self or others
      • A childhood diagnosis of conduct disorders
      • Lack of remorse for hurting others
      • Possessing a superficial charm or wit
      • Impulsiveness
      • A sense of extreme entitlement
      • Inability to make or keep friends
  • 6. Causes
    • The exact causes of antisocial personality disorder are unknown, but experts believe that both hereditary factors and environmental circumstances influence development of the condition.
    • A family history of the disorder — such as having an antisocial parent — increases your chances of developing the condition. A number of environmental factors within the childhood home, school and community also may contribute.
  • 7. Risk factors
    • Personality development is affected by genetic tendencies as well as environmental factors, such as childhood experiences. Most factors that increase the risk of developing antisocial personality relate to genetics and an abusive or neglectful childhood environment.
      • Having suffered from child abuse
      • Having a childhood environment of deprivation or neglect
      • Having an antisocial parent
      • Having an alcoholic parent
      • Being involved in a group of peers that exhibit antisocial behavior
      • Having an attention-deficit disorder
      • Having a reading disorder
    • Diagnosis of antisocial personality disorder is generally reserved for people older than 18. However, a positive diagnosis requires identification of a conduct disorder before the age of 15. These conduct disorders include bullying, stealing, truancy, cruelty to animals, vandalism and running away from home.
  • 8.
    • A diagnosis also requires at least three of the following:
      • A failure to conform to social norms
      • Consistent deceitfulness
      • Impulsiveness or a failure to plan ahead
      • Irritability and aggressiveness
      • A consistent disregard for work and family obligations
      • A consistent disregard for the safety of self and others
      • A lack of regret or remorse
  • 9. Complications
    • People with antisocial personality disorder are at an increased risk of:
      • Dying from a physical trauma, such as an accident
      • Drug and alcohol abuse
      • Suicide
      • Homicide
      • Other mental disorders such as depression, bipolar disorder and anxiety
      • Other personality disorders, particularly borderline and narcissistic personality disorders
      • Committing serious crimes that may result in imprisonment
  • 10. Treatments and drugs
    • Medications- People with antisocial personality disorder often suffer from associative conditions such as anxiety, depression, other mood disorders and substance abuse. Doctors may prescribe antidepressant or antipsychotic medications to help alleviate these conditions. Unfortunately, many people with antisocial personality disorder don't take their medications as prescribed.
    • Psychotherapy- This therapy can help people with antisocial personality disorder develop appropriate interpersonal skills and instill a moral code. A critical part of this therapy is developing and maintaining a strong therapist-patient relationship.
  • 11. Prevention
    • Because antisocial behavior has its roots in early adolescence, early intervention may help diminish the development of problem behaviors. As a parent or teacher, be on the lookout for antisocial children and take steps to help prevent or alleviate the behavior. These may include:
      • Reducing punitive methods of controlling behavior
      • Providing clear rules for conduct and discipline
      • Minimizing academic failures
      • Teaching critical social and interpersonal skills
      • Being consistent in applying consequences for bad behaviors
      • Teaching respect for others with ethnic, cultural or other differences
  • 12.
    • Personality Style
    • Shows superficial charm and easily make friends. Decision making is externally oriented. They show poor judgment and sometimes impulsive behavior, and justify and rationalize, and have difficulty learning from mistakes. They resent authority, tend to be competitive, but are poor losers.
    • Personality Disorder
    • Charm develops into a tendency to lie and "conn" others for profit or enjoyment. Decision making is more rigid and inflexible, and can be motivated by "getting even" for real or perceived "slights." Impulsiveness can lead to spur of the moment decisions that result in joblessness and homelessness. They externalize responsibility for behavior, and blame all problems on others. They can easily default on debts and obligations, and leave others suffering with no concern. Resentment of authority can take on an aggressive quality
    Cognitive Style
  • 13.
    • Lacks a sense or empathy as well as responsibility for the consequences of their actions
    • Adept at reading social situations and cues; uses this information to persuade others into meeting their needs. Assume others are like them, so seldom honest and open
    • Irresponsible with money sometimes, but able to work and support themselves, may be quite successful sometimes
    • Lack of empathy develops into a lack of guilt, shame, or even basic remorse for the harm they cause to others. Impulsivity and emptiness can lead to recklessness
    • Reads others to manipulate them because they see others as basically ways to gratify their desires.
    • Spend money carelessly, fail to honor financial obligations
    Emotional Functioning Relationships History
  • 14. Development
    • Psychodynamic - Meloy discussed the "stranger self-object." When the Antisocial was a child, he perceived his parents as being cold, uncaring, and likely to harm him. His introject, or basic template for people, does not include attachment, empathy, or trust. Without this, empathy can not develop, as well as shame or remorse
    • Biosociological - There is some evidence that Antisocials may develop from difficult temperament children or abused children. The children with irregular arousal patterns could become aggressive if the thresholds for stimulation are too low; thus they are quick to sense threat or danger.
    • Cognitive Behavioral - Cognitive Behavioral theorists say that Antisocials suffer from a number of mistaken cognitive beliefs.
    • 1) wanting something or wanting to avoid something is sufficient justification for acting in any way needed to obtain it or avoid it 2) thinking or feeling is a fact, and so if you think it is then it is true; the result is that you are always right
  • 15.
    • Interpersonal - Antisocial often have histories of abuse, neglectful parenting, and emotional trauma. They experience unpredictable discipline, had parents who were inconsistent and modeled putting their own needs first, learned little about sharing and being interdependent with others, develop a heightened need to establish their own independence from "bad" parents, and control others rather than be controlled. The emotional trauma they experience often leads to deep feelings of vulnerability and the rejection and lack of love they experience leads to shame.
  • 16. Treatment
    • Therapy as noted above is most helpful if it is problem focused. Gently awakening the buried feelings in the client and connecting them to current actions is the basic goal and process. However, you won't get very far; experiences that have been repressed for too long aren't going to come to the surface in the limited therapy time
    • Family therapy can be helpful. However, realize that you are basically working to coordinate the person's environment to work together to "gang up" on the client. If the entire family cooperates to make demands of the patient, and not give them any leeway to begin rationalizing and justifying their irresponsible behavior
    • The best treatment may be time. Antisocials don't come in for treatment much after age 35. They tend to have learned that some behaviors, while completely justified and reasonable for them of course (grin), end up causing more hassle than anything else. Thus, some antisocial behaviors are avoided to avoid the frustration and annoyance they cause.
  • 17. DIFFERENTIAL DIAGNOSIS
    • Narcissistic Personality Disorder- A Narcissist has much more access to a variety of emotions than an Antisocial, but typically does not show the conduct disordered behavior in youth, or the impulsivity and aggressiveness of the Antisocial. Further, Narcissists tend to feel more unhappy, depressed, and empty as their life progresses. They also have a sense of entitlement that Antisocial's don't have (i.e., "I deserve this" or "Rules about not getting this don't apply to me" versus "I want it and I'll take it" or "I want it and if you are dumb enough to let me..." without any thought to deserving or having a right to it).
    • Histrionic Personality Disorder- Histrionics may do Antisocial-seeming things, like maintaining affairs, being impulsive, or showing limited empathy for others, they don't engage in the conduct disordered behaviors or show the kind of coldness Antisocials do. Substance Abuse Disorders: Antisocials may have substance abuse or dependence, and you can diagnose both. Antisocial activities to support the drug habit can support both diagnosis.
  • 18. PSYCHOPATH
    • Psychopathy is a psychological construct that describes chronic immoral and antisocial behavior.[1] The term is often used interchangeably with sociopathy[2] . Psychopathy has been the most studied of any peresonality disorder. Today the term can legitimately be used in two ways. One is in the legal sense, "psychopathic personality disorder" under the Mental Health Act 1983 of the UK . The other use is as a severe form of the antisocial or dissociative personality disorder as exclusively defined by the Psychopathy Checklist-Revised (PCL-R) . [3] The term "psychopathy" is often confused with psychotic disorders. It is estimated that approximately one percent of the general population are psychopaths. They are overrepresented in prison systems , politics , law enforcement agencies , law firms, and in the media
    • The psychopath is defined by a continual seeking of psychological gratification in criminal, sexual, or aggressive impulses and the inability to learn from past mistakes.
    • Psychopathy is frequently co-morbid with other psychological disorders (particularly narcissistic personality disorder ). The psychopath differs slightly from the sociopath, and may differ even more so from an individual with an antisocial personality disorder diagnosis. Nevertheless, the three terms are frequently used interchangeably. While nearly all psychopaths have antisocial personality disorder, only some individuals with antisocial personality disorder are psychopaths
  • 19. Description
    • Lack of a conscience in conjunction with a weak ability to defer gratification in criminal, sexual and aggressive desires, leads to the psychopath to constantly engage in antisocial behaviors
    • Psychopaths (and others on the pathological narcissism scale) low in social cognition are more prone to violence against others, failure in occupational settings, and problems maintaining relationships. All psychopaths differ in their impulse control abilities, and overall desires. Psychopaths high in the pathological narcissism scale are more equipped to succeed, but pathological narcissism does not in any way guarantee success. Those that fall into the category of psychopath are vulnerable to a life of crime, poverty, and extremely poor interpersonal relationships
  • 20. CAUSES OF PSYCHOPATH
    • If a family member has had the disorder (especially the parents) it increases the chance of the disorder. A number of environmental factors in the childhood home, school, and community may also contribute to the disorder.
    • Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the fathers of individuals with antisocial personality disorder. He found that, within such a family, males had an increased incidence of APD, whereas females tended to show an increased incidence of somatization disorder
    • Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in the first five years of life. Glueck and Glueck (1968) saw reasons to believe that the mothers of children who developed this personality disorder usually did not discipline their children and showed little affection towards them.
  • 21. Symptoms
    • Common characteristics of those with psychopathy are:
      • Grandiose sense of self-worth
      • Superficial charm
      • Criminal versatility
      • Reckless disregard for the safety of self or others
      • Impulse control problems
      • Irresponsibility
      • Inability to tolerate boredom
      • Pathological narcissism
      • Pathological lying
  • 22. Symptoms
      • Shallow affect
      • Deceitfulness/manipulativeness
      • Aggressive or violent tendencies, repeated physical fights or assaults on others
      • Lack of empathy
      • Lack of remorse, indifferent to or rationalizes having hurt or mistreated others
      • A sense of extreme entitlement
      • Lack of or diminished levels of anxiety/nervousness and other emotions
      • Promiscuous sexual behavior, sexually deviant lifestyle
      • Poor judgment, failure to learn from experience
      • Lack of personal insight
      • Failure to follow any life plan
      • Abuse of drugs including alcohol
  • 23. POTENTIAL MARKERS
    • Even though antisocial personality disorder cannot be diagnosed before adulthood, the presence of three behavioral markers, known as the Macdonald triad , can be found in some children who go on to develop APD. The triad consists of bedwetting , a tendency to abuse animals , and pyromania [10] .
    • The number of children who exhibit these signs and grow up to develop antisocial personality disorder is unknown, but these signs are correlated with the traits of diagnosed adults. Because the number is unknown, this evidence is not yet ready to be permissible evidence of the disorder in a child.
  • 24. What is serial murder?
    • Definitions of serial murder/homicide differ between authors, but most agree that to qualify as a serial killer/murderer an offender must kill at least two victims in temporally unrelated incidents . This temporal criterion is usually satisfied by a "cooling off" or "refractory" period between killings, ranging from hours to years.
    • A serial murderer will be defined as a person who kills two or more victims in incidents that are geographically and temporally unrelated. The key element in serial murder is that the series of murders do not share in the events surrounding one another.
    • Serial murder occurs when one or more individuals commits a second murder and/or subsequent murder; is relationship less (victim and attackers are strangers); occurs at a different time and has no connection to the initial (and subsequent) murder; and is frequently committed in a different geographic location
  • 25. The typology of serial murder
    • The National Centre for the Analysis of Violent Crime (NCAVC) at the FBI Academy in Quantico, Virginia, US, divides serial murder into two types: "spree" and "classic". Spree serial murder satisfies the criteria of geographical separation, but rarely is there a "cooling off" period. The motive is usually financial and/or thrill-seeking. Classic serial murder satisfies both criteria: a predatory/stalking method is typically employed, and crime-scene evidence often suggests a sexual/sadistic motive.
    • Dietz (1986) presents a more detailed serial killer typology: (i) psychopathic sexual sadists (who torture and kill for pleasure); (ii) crime spree killers (as above); (iii) organized crime members (mafia, street gangs etc. who kill for instrumental/financial/territorial/retaliative purposes); (iv) custodial poisoners and asphyxiators (e.g. serial killings in nursing homes); and (v) supposed psychotics (those whose crimes occur as a result of psychotic delusions).
  • 26.
    • Ressler et al . (1988) argue that the classification of serial killers is enhanced (particularly in relation to their apprehension) by classification into "organized" and "disorganized" offenders, based upon crime scene evidence. Organized crime scenes reflect evidence of a well-planned, repetitive, and skillfully-executed "production" distinguishable from the spontaneous/chaotic acts of disorganized offenders.
    • The disorganized offender is likely to leave evidence and weapons at the scene, position the dead body, perform sexual acts after victim death (necrophilic behavior), try to depersonalize the victim, and not use a vehicle.
  • 27.
    • Hedonistic - This group may be divided into sub-types. Lust murderers kill for sexual enjoyment (see erotophonophiliacs, above).
    • Thrill-oriented killers- kill for the excitement of a novel experience. Both of these sub-types may show evidence of sadistic methods, mutilation, dismemberment, and pre- and post-mortem sexual activity.
    • Comfort-oriented killers- commit act-focused crimes (i.e. those instrumental in killing their victim, rather than focusing on the killing process). The motive may be psychological or financial gratification
    • Power and control- This offender is motivated by a desire for complete power and control over his victim. Sexual activity may occur, although this is used as an means of domination rather than for primary sexual gratification
  • 28. The final typology
    • Professional killer- Kills for direct payment
    • Career criminal- who kills Killing is secondary but instrumental to other criminal activity e.g. in drug cartel disputes.
    • Killer-amateur criminal -Murder is separate from other criminal activity (but minor crimes are often engaged in).
    • Strictly amateur- Serial murder is the sole crime of the offender .
  • 29. The prevalence of serial murder
    • such reports do nothing to estimate the "dark figure" of serial murder. Estimation of serial murder prevalence ranges hugely. Claims tend not to be conservative, as if to inflate the importance of the various authors’ research into serial murder
  • 30. THE SERIAL SEXUAL MURDERER
    • Those who have been once intoxicated with power, and have derived any kind of emolument from it, even though but for one year, never can willingly abandon it. They may be distressed in the midst of all their power; but they will never look to anything but power for their relief".
  • 31. Crime characteristics
    • The offence thus begins with the abduction of a victim, triggered by fantastic urges experienced by the offender. An ideal victim may be sought, but often the offender will "make do", especially if no opportunity to seize an ideal victim has recently occurred. Victims may be tricked into accompanying the .offender (who may impersonate someone in authority, especially police; many serial murderers are described as “policies groupies”
    • Methods of torture include the use of hammers, pliers, whips, and burning by flame or electric shock
    • Bite marks may be found, and evidence of vampirism (drinking of blood) or anthropophagy (cannibalism) is sometimes reported.
    • Serial sexual offenders will often kill by "hands-on" methods such as strangulation, asphyxiation and mutilation rather than use firearms. This " modus operandi " (MO) tends to remain constant throughout offences, deviating (if ever) only towards the end of an offender’s murder series as he becomes more disorganised
  • 32. SOCIO-CULTURAL APPROACHES TO SERIAL MURDER
    • Socio-cultural theories of serial murder have been largely overlooked in the current literature, possibly because of a feeling of both lay and academic unease that such a horrific crime could be a product of an individual’s social milieu.
    • It is possible to identify important sociological theories that might have some bearing upon an explanation of serial killing. In attributing the effects of the environment/social milieu, we must be careful in attributing consciousness and free-will.
  • 33. Structural/functionalist approaches
    • Deviance and crime represent a breakdown in a social consensus regarding societies goals and values. Serial murder lends itself well to Durkheim’s idea that a high rate of crime in mechanistic (those which have advanced from an organic basis) societies represents a feeling of anomie , or helplessness or normlessness, in such societies.
    • Suicide is more easily understandable as an expression of anomie, but further research and theorization into the role of homicide and serial homicide as a consequence of anomie would be of great interest
  • 34. PSYCHIATRIC APPROACHES TO SERIAL MURDER
    • If psychiatry’s role is to explain and treat human behaviour that deviates from the norm, then shedding light on serial murder must surely be an ultimate goal
    • The acts of the serial murderer are often seen as so horrific and beyond understanding that the perpetrator must be insane. This "re ipsa loquitor " (the act speaks for itself) heuristic approach is a dangerous one, as a large range of studies (e.g. Teplin, 1985) do not support the stereotype of mentally ill persons as violent and dangerous
  • 35. Psychosis and schizophrenia
    • Clearly, overt psychotic illness (especially that characterised by a predominance of positive symptoms of a paranoid nature) has a direct influence on some acts of serial murder (e.g. those of P. Sutcliffe and other visionary serial murderers), but this type of influence is either uncommon, or evidence testifying to that effect is simply ignored in a court of law
    • asserts that all mass killers are insane, and this madness takes one of two forms:
      • (i) paranoid schizophrenia characterised by positive psychotic symptoms (auditory and visual hallucinations and delusions particularly of a persecutory, grandiose, religious, suspicious, and aggressive content); or
      • (ii) sexual sadists (a condition characterised by torturing, killing and mutilating other persons). Lunde is, however, making the ultimate psychiatric error - that because behaviour deviates from the norm, mental disorder must be present. Simple deviance cannot be instantly equated to illness.
  • 36.   Multiple personality disorder (MPD) and dissociative disorders
    • The diagnosis of MPD has been raised in conjunction with the defenses of a number of captured serial murderers, most notably in the case of K. Bianchi. MPD is a psychological disorder, sometimes occurring as a symptom of schizophrenia, in which a person exhibits two or more disassociated personalities, each functioning as a distinct entity. The construct has received much criticism in psychiatry, and many refuse to accept it as a valid disorder.
    • While many serial murderers appear to have "two sides" - a presentable side to society and a side that commits unspeakable crimes - we must obtain corroborating evidence concerning distinct pre-existing personalities with specific behavior patterns and social relationships prior to offending.
  • 37. Neurotic disorders
    • Murderers have higher scores on both psychoticism and neuroticism inventories than other subjects
    • Little connection has been made, particularly concerning the role of cognition in serial murder, with the extensive literature that exists on clinical depression and associated cognitions
    • As an extreme example, perhaps serial murder can be reduced to a process analogous to the depressed patient’s resort to alcohol, in a vain attempt to restore normal mental health
    • The usual state of the serial murder is distorted thinking that allows him to believe he is naturally superior and dominant to others around him.
  • 38. The role of psychopathy
    • Psychopathic personality disorder (PPD) is a persistent disorder or disability of mind resulting in abnormally aggressive or irresponsible behaviour that is not the product of psychosis or other illness. Psychopaths (also termed sociopaths) behave in a socially unacceptable manner (though they may show superficial charm and good intelligence) often with adverse affects on themselves and others; they may leave behind them a characteristic "chain of chaos" (Reid, 1978).
    • Criminal behaviour is often seen as a symptom of psychopathy (DSM-IV describes "repeatedly performing acts that are grounds for arrest" as a diagnostic category for Antisocial Personality Disorder - a condition analogous to PPD)
    • Psychopathy is likely to play a role in the internal justification of serial murder, and may well predict serial rather than single homicide offenders. Those who feel guilt about their crimes are less likely to commit them again.
  • 39. Dissocial personality disorder
    • Dissocial personality disorder is one of several psychopathic personality disorders , each of which has different operational definitions and terminologies depending on the system of classification of mental disorders used. [1] Psychopathy is a general construct that differs from the specific diagnoses of antisocial , psychopathic, dissocial, and sociopathic personality disorders, the various diagnostic classifications for psychopathy
    • The criteria for antisocial personality disorder are largely based on observable behaviors while the ICD criteria for dissocial personality disorder focus more on the affective and interpersonal deficits. However, the ICD criteria do not represent the broad personality and behavioral factors of psychopathy
    • The blurring of distinctions between these diagnostic categories and psychopathy have caused diagnosis confusion. For the mental health and criminal justice system, the distinction between psychopathy and antisocial personality disorder is of considerable importance.
  • 40.