Hare Psychopathy Checklist - Other Mental Disorders

Other Mental Disorders

Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder.

The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are misnomers. The World Health Organization takes a different stance in its ICD-10 by referring to psychopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.

Among laypersons and professionals, there is much confusion about the meanings and differences between psychopathy, sociopathy, antisocial personality disorder, and the ICD-10 diagnosis, dissocial personality disorder. Hare takes the stance that psychopathy as a syndrome should be considered distinct from the DSM-IV's antisocial personality disorder construct, even though ASPD and psychopathy were intended to be equivalent in the DSM-IV. However, those who created the DSM-IV felt that there was too much room for subjectivity on the part of clinicians when identifying things like remorse and guilt; therefore, the DSM-IV panel decided to stick to observable behaviour, namely socially deviant behaviours.

As a result, the diagnosis of ASPD is something that the "majority of criminals easily meet". Hare goes further to say that the percentage of incarcerated criminals that meet the requirements of ASPD is somewhere between 80 and 85 percent, whereas only about 20% of these criminals would qualify for a diagnosis of what Hare's scale considers to be a psychopath. This twenty percent, according to Hare, accounts for 50 percent of all the most serious crimes committed, including half of all serial and repeat rapists. According to FBI reports, 44 percent of all police officer murders in 1992 were committed by psychopaths.

Another study using the PCL-R to examine the relationship between antisocial behaviour and suicide found that suicide history was strongly correlated to PCL-R factor 2 (reflecting antisocial deviance) and was not correlated to PCL-R factor 1 (reflecting affective functioning). Given that ASPD relates to factor 2, whereas psychopathy relates to both factors, this would confirm Hervey M. Cleckley's assertion that psychopaths are relatively immune to suicide. People with ASPD, on the other hand, have a relatively high suicide rate.

Since psychopaths frequently cause harm through their actions, it is assumed that they are not emotionally attached to the people they harm; however, according to the PCL-R checklist, psychopaths are also careless in the way they treat themselves. They frequently fail to alter their behavior in a way that would prevent them from enduring future discomfort.

In practice, mental health professionals rarely treat psychopathic personality disorders as they are considered untreatable and no interventions have proved to be effective. In England and Wales the diagnosis of dissocial personality disorder is grounds for detention in secure psychiatric hospitals under the Mental Health Act 1983 if they have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment this alternative to prison is not often used.

Because an individual's scores may have important consequences for his or her future, the potential for harm if the test is used or administered incorrectly is considerable. The test can only be considered valid if administered by a suitably qualified and experienced clinician under controlled conditions.

Hare wants the Diagnostic and Statistical Manual of Mental Disorders to list psychopathy as a unique disorder, saying psychopathy has no precise equivalent in either the DSM-IV-TR, where it is most strongly correlated with the diagnosis of antisocial personality disorder, or the ICD-10, which has a partly similar condition called dissocial personality disorder. Both organizations view the terms as synonymous. But only a minority of those in institutions whom Hare and his followers would diagnose as psychopaths are violent offenders.

The manipulative skills of some of the others are valued for providing audacious leadership. It is argued psychopathy is adaptive in a highly competitive environment, because it gets results for both the individual and the corporations or, often small political sects they represent. However, these individuals will often cause long-term harm, both to their co-workers and the organization as a whole, due to their manipulative, deceitful, abusive, and fraudulent behaviour.

Hare describes people he calls psychopaths as "intraspecies predators who use charm, manipulation, intimidation, sex and violence to control others and to satisfy their own selfish needs. Lacking in conscience and empathy, they take what they want and do as they please, violating social norms and expectations without guilt or remorse". He contends that they lack "the very qualities that allow a human being to live in social harmony".