In some people, psychopathy goes undetected. A recent UC Berkeley study offers a solution.

Anne Brice (Intro): This is Berkeley Voices, a UC Berkeley News podcast. I’m Anne Brice. For this season of the podcast, we’re trying something new. We’ll have a theme that will thread together a series of episodes. This year’s theme is transformation. In eight episodes, we’ll explore how transformation — of ideas, of research, of perspective — shows up in the work that happens every day at UC Berkeley. New episodes will come out on the last Monday of each month, from October through May. 

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Anne Brice: If someone asked you to imagine a psychopath, what would you picture? I think a lot of us might conjure an image of a violent criminal who will do anything to anyone to get what they want without remorse. After all, it’s what we’ve seen in countless movies and other depictions over the decades. 

But this doesn’t accurately describe all people with psychopathic personality disorder. Rather, it describes the most extreme cases of psychopathy.  

That’s according to UC Berkeley psychology professor Keanan Joyner. 

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Keanan Joyner: I’m an assistant professor of psychology, primarily in the clinical science area. I run the Clinical Research on Externalizing and Addiction Mechanisms Laboratory.

Anne Brice: At the lab, Joyner and his team study risk for addiction and why problematic drug use cooccurs with mental disorders. One of the disorders they study is psychopathy. 

Joyner says that some people who have psychopathy are likely going undetected, in large part because of how it’s measured. 

In a study published in the journal Psychological Assessment in June of this year, Joyner and his colleagues found that there’s a more effective system for identifying psychopathy, which is one of several personality disorders that cause a lot of harm in society. It’s estimated that each year the cost of psychopathy to the U.S. criminal justice system is upward of $460 billion.

Keanan Joyner: If we understand better what these things are — why they occur in the population, how to identify them, the more that we can solve those and intervene early, the better for everyone in society, especially the person with these conditions.

All of that, I think, goes towards a general public health goal of trying to improve interpersonal and an individual kind of flourishing, human flourishing, and I think that that’s an important goal. 

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Anne Brice: To understand how Joyner and his colleagues are proposing we identify psychopathy, it’s important to know how the disorder is currently assessed. 

As it is today, psychopathic personality is measured using the 20-item psychopathy checklist, originally developed in the 1970s by Canadian psychologist Robert Hare for use in psychology experiments. The checklist looks for a range of symptoms, from superficial charm and pathological lying to exploitation of others for personal gain. The checklist is then used as a specifier for antisocial personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, or the DSM.

Joyner is quick to point out that the DSM is not a ground-truth document, and that a person with psychopathy could have a lot of other symptoms, too. 

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Keanan Joyner: Some people, I think, assume that these are the only symptoms of the disorder because it’s written in the DSM. The DSM wasn’t planned for that, as a science document. It was actually planned as a science policy document, which means we need to be able to have codes that we can bill for for Medicare and insurance. 

And we have to make binary decisions. We have to say yes, no for those who get treatment, who get medication, all these types of things. So the symptoms here are not comprehensive of every symptom that could exist.

I often like to use the example of depression because it’s obviously so common and impairing, and we’re all typically pretty familiar with it. We all agree it exists. Obviously something like depression construct exists in people. We all understand it’s not just getting sad, it’s something more than that. But I don’t think that anybody would read through the nine symptoms of depression in the DSM and say, “Yep, that covers the entire spectrum of what it is to be depressed.” These are the best indicators that we have come up with as a field that is very, very useful to be able to be talking about the same things and to be able to make these decisions that we have to make for how to treat patients and so on and so forth.

Anne Brice: In the DSM, psychopathy isn’t categorized as its own disorder. Instead, it’s a subset of antisocial personality disorder. So a person with psychopathy would be diagnosed with antisocial personality disorder with psychopathic features. 

That means for a person to be screened for psychopathy, they first need to meet the criteria of antisocial personality disorder, which isn’t always a perfect fit. 

For example, to be diagnosed with antisocial personality disorder, you need to have evidence of conduct disorder, like setting fires or torturing animals, before the age of 15. 

But Joyner says there’s a big reason psychopaths might not get caught in their disorderly conduct: They have a specific trait that’s largely overlooked in the current diagnostic method. 

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And this trait is central to the new system that Joyner and his colleagues propose in their study. 

Anne Brice: To capture psychopathy’s key elements, Joyner and his team found that the Elemental Psychopathy Assessment, or EPA, is more in-depth and nuanced than the currently used psychopathy checklist. 

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And instead of using the DSM to assess and categorize the personality disorder, they usd something called the triarchic model. 

The model posits that there are three personality dimensions that underlie psychopathy: disinhibition, which we often call impulsivity; callousness, or meanness and lack of empathy; and boldness, the lack of fear. 

Keanan Joyner: The really important part of this theory, and what differentiates it, is that you now have this other dimension that’s going to be what we call orthogonal, or uncorrelated, with impulsivity, those disinhibition pieces, that we call boldness.

And this on its own, if you didn’t have any impulsivity and you didn’t have any callousness, is actually extremely adaptive. 

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It actually is responsible for lack of anxiety, is responsible for sociability, for social persuasiveness, leadership capacities, these types of things that are also associated again with that first glance at psychopathy.

Anne Brice: Joyner says it’s important to understand that in this new method, what we think of as personality “traits” become personality “dimensions.” 

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So rather than simply having or not having a trait, like confidence, say, Joyner and his colleagues measure how much or how little of it one possesses.

And instead of relying on self-reported symptoms in interviews and the psychopathy checklist, as they do currently, practitioners in the new system also look at brain scans and how a person acts when they’re being tested. 

While there isn’t a switch in the brain that just turns on and makes a person a psychopath, Joyner says, there are neural processes that are correlated to psychopathy. 

Keanan Joyner: For example, face emotion processing. We know that faces are processed usually in the fusiform face area in the brain, but it’s also a distributed network through the frontal cortices, as well, where we represent what it means to see someone’s face in distress, for example.

You can imagine being fearful and that if you see someone else’s face is fearful, there’s both something about reacting to their fear, but it’s also indicative of someone else is fearful. 

We’re a human species that have evolved together. And that may be indicating that I should actually be fearful of something out here. Right? So it communicates something to me about me as well as me just reading about them. 

So there are these multiple cognitive layers that are a little bit more abstracted. And anyways, all that to say is in psychopathy, those types of processes, those neural processes, are correlated with some of these features, particularly the empathy features.

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Anne Brice: So psychopathy is multidimensional, and like in all personalities, these dimensions exist on a spectrum and are expressed in different ways. 

Keanan Joyner: Back in my days when I was doing therapy, providing therapy in graduate school, I would always try to remind clients who were worried about whether their partner was or was not a narcissist. 

And I would try to remind them that it doesn’t matter if they’re a narcissist. It’s what level of narcissism is happening that it’s hurting you in this relationship, right? Is it negative? Is it bringing about negative outcomes? OK then, they are acting narcissistic and it doesn’t matter whether they’ve crossed the threshold or not. There’s negative outcomes associated with that. 

So I’d say the same thing about psychopathy. If you’re looking at, like, is my partner a psychopath? Or is a brother, friend, cousin, mother, whatever, a psychopath? I think that’s maybe a little bit less of an important question than: Are they psychopathic to a certain extent that it’s causing other people harm or themselves? 

Anne Brice: But Joyner recognizes it’s natural for humans to want to categorize things to help make sense of them. And along that vein, he says it’s OK to try to categorize psychopathy. 

So what then is the definition of a psychopath? 

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Joyner says a psychopath is a person who has high levels of all three personality dimensions associated with psychopathy, so high in boldness, high in callousness and high in disinhibition. 

Keanan Joyner: That small percentage of the population is then that sinister presentation that captures the media attention so much.

I think as long as we just remind ourselves, like, this is a linguistic thing. So it’s not like we can never say someone’s a psychopath. It’s just that that language sometimes reinstantiates a misunderstanding, which is reminding everybody that these things are dimensions, and you can get high enough on these dimensions that it would be fine and accurate to say psychopath, but they still exist dimensionally.

Anne Brice: These personality dimensions as defined in the triarchic model, are consistent with the most prominent theories of psychopathy, first documented by American psychiatrist Hervey Cleckley in his 1941 book, The Mask of Sanity. In the book, he writes about the role of boldness. 

Keanan Joyner: He’s talking about people who, when you first meet them, actually are really likable. They’re very sociable. They’re very persuasive. Typically, [they have] social leadership-type capabilities and propensities. 

And as you continue to interact with them, you realize that is a mask of sanity, that the overall kind of charming personality-style, social persuasiveness, leadership, those types of things, are masking a lot of dysfunction behind that, that has to do with impulsive, antisocial tendencies, actions and behaviors. 

Anne Brice: This bold dimension of their personalities also helps explain facets of psychopathy that have confused psychologists for decades.

Keanan Joyner: Pretty early on, I mean, back in, we’re talking much before I was born, certainly (laughs), people were noticing that, hey, there’s this subgroup, again, of antisocial folks that we consider psychopaths. And what’s so odd about them is that almost every mental illness, and antisocial personality is no exception, is associated with increased risk suicide risk, increased risk of dying by suicide. And that makes quite a lot of sense for most mental illnesses. 

However, for this small subgroup, they were at massively decreased risk of dying by suicide. They’re also at decreased risk of ever showing up to get some help with mental illness. So they weren’t help-seeking. They’re confident, and we would often call them impervious. They’re not actually very distressed by these types of things. They’re self-justified, they’re confident, they’re bold. 

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Anne Brice: Joyner says that people with psychopathic features, and even true psychopaths with lower antisocial dimensions to their personalities, can be very beneficial to society. In fact, they’re an essential part of humanity that, in certain contexts, help us all thrive as a species.

Anne Brice: In the current system that we use to measure and assess psychopathy, a person with the disorder has to have a criminal history.  

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Keanan Joyner: There’s nothing about criminality that is actually required for psychopathy, but that’s in the psychopathy checklist. So this is where it gets very difficult to think about symptoms. To go back to what I said, I think worth highlighting, is that when we think about symptoms of a mental disorder, having that symptom doesn’t cause you to have that mental disorder; it is one of the reflections of the mental disorder. And I do think that criminality is often a reflection of psychopathy. But we will turn that arrow because of how we talk about it, and we say, “Now, it’s part of the definition of psychopathy.”

Anne Brice: In a 2012 study, psychologists ranked 42 U.S. presidents on the presence of psychopathic traits and found that those with fearless dominance, which reflects the boldness present in psychopathy, were associated with better-rated presidential performance, crisis management and leadership, among other positive traits. 

And there’s another study from 2018 that found that a person high in boldness predicts professional success, especially in sales. 

But it’s not just boldness that can be beneficial. The other two traits — callousness and disinhibition — can have positive applications, as well. 

In 2019, Joyner cowrote a chapter for The SAGE Encyclopedia of Criminal Psychology about why, from an evolutionary perspective, psychopathy exists. 

Keanan Joyner: It’s really important to realize that each of these traits on their own are actually very adaptive to have in the population. 

We don’t think that is a lack of empathy when a surgeon has to cut someone’s arm open to fix something. And it’s probably good for their job and profession to not be as distressed by that as I might be to cut someone’s arm open. That’s a good, adaptive thing, right? 

The same thing for something like disinhibition. Even though that sounds like it might always be maladaptive, it’s not. You need people who are going to explore. Imagine back in hunter-gatherer days: If no one ever leaves the camp, we’re not really going to get any of this progress that we’ve enjoyed as a species. So you need novelty seekers. And so all of these traits each have things that are adaptive and maladaptive about them in a certain context. 

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Anne Brice: There are some environmental contexts, Joyner says, in which being bold, callous and disinhibited is very helpful, if not necessary. 

Keanan Joyner: Our criminal justice system fails tons of people every year that are horribly socioeconomically disadvantaged, and we sequester them into unsafe sections of cities where, yeah, maybe if you are a bit overconfident and maybe dispositionally aggressive, maybe that actually keeps you safe. Right? 

So you put a child into that situation, and you tell them, “You have to walk home from school alone, because mom has to work two jobs to be able to make ends meet. And so you have to watch yourself. You have to keep yourself safe.” So for survival, it might be adaptive for them to learn: I need to develop a bravado. I need to maybe respond to aggression with some aggression to deter future aggression. 

And so you can imagine a set of environmental contingencies that would cause people to develop more and more of certain traits to fit their environment. And that may actually be adaptive in that environment. 

And then when you remove them from that environment, those things now become maladaptive. 

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And that’s a situation that’s a little bit more complicated than, “Are things good or bad? Or are traits adaptive [or] maladaptive?” It’s going to be a match between the demands of your environment with whether that trait is adaptive or maladaptive. 

Anne Brice: These unsafe neighborhoods are also overpoliced, he says. This makes people who live in these environments more likely to be criminalized, when others with more power in society are less likely to be caught and prosecuted. 

In 2022, Joyner copublished a commentary arguing that in order to accurately assess the crime cost of psychopathic personality disorder, it’s vital to include the criminal justice context.

Keanan Joyner: As a Black man, I certainly can identify all of the structural situations in our country that might increase my risk of interfacing with the police. This is kind of now passing into another one of my areas of work in the lab that I’ve been writing about quite a bit recently, is thinking about the very real ways in which racial dynamics in this country, and also individual racial experiences, can creep into our measurement of things. 

So we can think about stop-and-frisk in New York City. Right? Black people did not have a higher rate of having cannabis or other illegal substances or something on them than white people. But Black people ended up being the only ones that got frisked and therefore the only ones that got caught. And I’m obviously being quite liberal with the word “only” — it was just disproportionate to their size of the population where they were being stopped and frisked. 

So now if you go by the legal involvement numbers, you have this huge proportion of Black men, in particular, who are being caught for drug use, let’s say, but they don’t actually have any higher drug use than their white counterparts. Right?

Anne Brice: The same logic applies to the psychopathy checklist, Joyner says, because it doesn’t take into account the wide range of environmental factors that can determine if a person’s crime is detected or not. 

Keanan Joyner: If you are affluent, powerful, let’s say, maybe, of some sort of a majority advantaged group, if you want to just have that broad umbrella across different contexts, your crimes are less likely to be detected. Therefore, your psychopathy score would immediately be lowered by virtue of not being caught, right? (Laughs)

And so it’s kind of circularly baked into that kind of construct and those environmental determinants or identity factors because of the current context of our American legal system and policing system may differentially inflate or deflate scores on that dimension.    

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Anne Brice: Joyner acknowledges that many in the scientific community don’t believe that psychopathy should be diagnosed, and instead we need to focus on its harms in society. 

But Joyner argues that, with more knowledge, we have a better chance at alleviating the damaging effects of the disorder before they even become a costly problem to begin with.  

Keanan Joyner: I think that it goes towards having a functional and positive society, that we generally want people to be prosocial, to work together. Our collaboration is the substance of what makes humans so wonderful as a species.

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Anne Brice (Outro): I’m Anne Brice, and this is Berkeley Voices, a UC Berkeley News podcast from the Office of Communications and Public Affairs at UC Berkeley. If you like what we do, please tell a friend and leave us a review on Apple Podcasts. New episodes come out on the last Monday of each month. 

We also have another show, Berkeley Talks, that features lectures and conversations at UC Berkeley. You can find all of our podcast episodes, with transcripts and photos, on UC Berkeley News at news.berkeley.edu/podcasts.

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