Experienced clinician says psychopathy is a spectrum

This week we are continuing to discuss The Psychopathic Mind by J. Reid Meloy, Ph.D. The author is diplomate in forensic psychology, former Chief of the Forensic Mental Health Division for San Diego County and Past President of the American Academy of Forensic Psychology. As I said last week, my initial reaction to the book was rather negative because I believe this author has made some assertions that have become the basis for inaccurate folklore that has spread over the internet (to be discussed in the coming weeks). But Dr. Meloy made up for all that by setting the record straight on a very important issue—the spectrum of psychopathy.

The idea that psychopathy is a spectrum and that “sociopaths/psychopaths” vary in severity means that there is no real point at which “normal” stops and “sociopath/psychopath” starts. Any decision about where to draw this line (after gathering information on a large group of people) is in a sense arbitrary.

The idea that “psychopathic disturbance” (as Dr. Meloy calls it) is a spectrum can be very confusing. Many people feel a sense of relief when they finally figure out that the person who has harmed them is “a sociopath.” By “sociopath” they mean categorically different from everyone else, a different type of human. Now I am saying there is really no category, just an extreme on a continuum.

I want to point out that we talk about the extremes of the continuum of traits as if they are categories all the time. Think about the adjectives tall, genius, beautiful, athletic etc. and you will realize that although these concepts exist in theory, it can be difficult to correctly place individuals into any of these categories on a strictly yes/no basis. The only time it is easy is when you are dealing with the extreme cases.

It is however; very important to understand how the interaction between spectra and categories affects us. For example, if you are used to being with players in the NBA, most everyone outside of the NBA will seem “short” and the perception of “tall” will also be skewed. To the NBA, 6’2″ is short!

This problem of perception while in the midst of an extreme population has created a problem for forensic psychology. When Dr. Hare first developed the psychopathy checklist, it was thought to differentiate criminals who are “psychopaths” from other criminals who are “not psychopaths.” Well, I maintain that this is exactly the same as calling a 6’2″ NBA player “short.”

I am also concerned with how our perception of psychopathy changes when we see it in the community. When we are in the community a person who has “a little” psychopathy stands out as a 6’2″ person would in a crowd. Many pose the question, “Is my _______ a jerk or a psychopath?” When we understand psychopathy as a spectrum we see that such distinctions are not very useful. It is more useful to ask “How much psychopathic disturbance does my ________ have?”

I have looked extensively in the scientific literature for the exact Psychopathy Checklist (PCL-R) scores that might indicate mild, moderate and severe psychopathic disturbance. If you are following what I am saying you will immediately realize that these definitions are important in determining just how many “psychopaths” there are. When I searched the literature several years ago, I reported on this blog that about 10% of the population has significant psychopathy. That 10% figure corresponds to a cut-off score of about 12 on the PCL-R.

In The Psychopathic Mind, p. 318 Dr. Meloy says the following:

Mild psychopathic disturbance 10-19

Moderate psychopathic disturbance 20-29

Severe psychopathic disturbance 30-40

This is more or less what I also determined given my clinical experience and reading of the literature. You might ask why I harp on this so much and why am I harping on it again? The reason I bring this all up is to help those of you who are stuck in a relationship with someone who has “mild psychopathic disturbance.” Steve Becker also talked about the problem of “mild psychopathy” this week When he’s just a bad dude, though he did not call it that.

In what I am about to say I depart from Meloy and give you my own opinion.

The nature of “Mild Psychopathy”

Psychopathic disturbance as Meloy also describes it is a disorder of motives. Since we all have these motives psychopathy is a spectrum. Psychopathy is an imbalance between love and power motives along with degrees of poor impulse control.

A person who is severely affected with psychopathy has no love motives at all. If we could perfectly measure the love motive, we could indeed form a category of those who have NO capacity for love. That category probably also includes some individuals with “moderate disturbance” and all with “severe disturbance.”

Individuals with mild psychopathy have some ability to love. Because they can love a little, what they do is particularly harmful to “loved ones.” They switch back and forth, in and out of “loving” states. When they are in a loving state, they truly have no emotional or other memory of their experiences outside of that state. Similarly when they are in the “power mode” they have no access to the memories of the love mode. It’s as if they have a split personality. Their poor partner is left asking, “Will the real ________ please stand up?”

The dilemma for partners and family members, is that both states are real. Those involved with the “mildly psychopathic” have to make a tough decision. They have to decide whether or not to let go of a person who they have shared real intimacy with. That is much harder than letting go of someone with severe psychopathic disturbance where the entire relationship was a sham.

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172 Comments on "Experienced clinician says psychopathy is a spectrum"

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i disagree with the premise of this theory. I think it is misleading on any level to label someone as “mildly psychopathic”.
A rose by any other name..
Perhaps I might be misinterpreting this, but a guy whose just plain mean sometimes, yet has the ability to love- that ain’t mildly sociopathic. That’s his personality. There is no “ability to love” in a psychopath, PERIOD. And if he does have an ability to love, he ISN’T a sociopath. Normal people do heinous things too… crimes of passion and the like, chemical imbalances, bad anger management… but this really makes things fuzzy. I think one of the issues with modern day psychology is that it focuses too narrowly on the semantics of things. If you mark 5 out of 15 traits of X list, then you are X.

Normal people can be “grandiose” but not in the same way psychopaths are. This just lends to a high possible chance of future misdiagnoses… Normal people can “steal” given the circumstances ( just because you have “stolen” does not make you a sociopath. for example factors which can affect this : peer pressure, socioeconomic status, environment, culture, etc )… if we go by this “mildly” sociopathic list… then half of all adolescents may as well be categorized as MILDLY sociopathic. or careless, mindless adolescents who are not actually psychopaths. The distinction needs to be clear.

Partly my ambivalence to this topic is my apprehension of anyone claiming any sociopath is “less harmful” than another… I interpreted the scale of sociopathy more on what acts the individual has manifested/carried out.. Anyway… thats my two cents.

Extremely powerful article and subsequent postings



Diabetes is a disease that you either have or don’t have, like you are not “partly” diabetic, or you are not “partly” pregnant or partly dead, you either is or you aint.

However, you can be a “seriously” diabetic that is difficult to control your sugars and you are seriously ill, or you can have a mild case of type II as I have that is controlable with diet and exercise. Or you can be 1 day preg or ready to pop out a baby, and as far as dead is concerned I guess you can be newly dead and still warm or a mummy! LOL

I see what Dr. Leedom means about it being a range of behaviors and a range of disordered as well. It is sort of like I think “where does short stop and tall begin?” Or where is the line between dumb and smart? between retarded and genius? There is a variation between the IQ of retarded (about 74) and Genius (140) but what about the guy who is 75 or 76, is he retarded or not? What about the guy who is 139 is he a genius or smart? The cut off between smart and retarded is a gradual change not an “is or aint,” and I think that is what Dr. Leedom is expressing.

Oxy, I couldn’t agree more. Further, this is fascinating stuff if I get into research and statistics about it.

But for right now, toxic is just plain toxic, no matter the labels! Great read!

Dear LL, finally I found the article about toxic people that helped me a lot. I think from what I read that you are doing great! Have a nice relaxing weekend

(((Hugs))) Libelle

Having been married a long time to someone I might rate at about 25 on this PCL-R list, I do not buy the split personality view. In retrospect, after learning about psychopathy, and after he had less and less reason to keep his mask on, it became very evident that he knew exactly what he was doing, and he loved it. There were some shallow emotions that probably were genuine, but these were often warped by his narcissistic worldview. Were there many times when he seemed loving? Yes. But now they seem undermined by his delight in duping me. He intimates he had me fooled all along. His attempts to get me back when I filed for divorce were not convincing.

See George Simon’s Wolf in Sheep’s Clothing book for more on how much they do or do not know about what they do.

I concur with your recommendation of George Simon’s book, Wolf in Sheeps Clothing. And I have his book Character Disturbance as well.

Character Disturbance is easier for people to accept than sociopath or psychopath. It’s hard reading because I found aspect after aspect of my ex in there. Nobody wants to think they’ve been so intimate with someone so disturbed in their thinking that they would PURPOSELY cause such terrible harm. But it wasn’t until I accepted a basic truth, that my ex engaged in ALL relationships from an adversarial perspective, then I understood why he thought scamming me, undermining me, hurting me was no big deal. Because doing terrible mindtricks and sabotaging me was his way of WINNING, of getting one over on me and everyone he dealt with. His duping delight was especially painful, that he could destroy me and have such glee about it. Yep, it was because he prevailed over his main adversary. Me. It also explained why he did things that were not in HIS best interest either. Again, his need to WIN mattered more than the time he lost MILLIONS in a business deal because he was too busy WINNING to pay attention to business. But as someone who has no emotions about it, he didn’t care. He counted the loss of MILLIONS as a win because I couldn’t make a claim against it as a marital asset. The fact that I wasn’t going to make a claim? Not a factor for him. He still enjoyed it as a WIN against me, his adversary.

ALL our good times, our “special” moments, those memories are tainted, destroyed because instead of the exception in my bad marriage, I found out they were manipulations to set me up for a loss. Again, his WIN.

That’s why ALL my efforts to recover our marriage was NEVER going to happen, because that would be a LOSS for him, something he would never allow to happen. Anything I wanted or valued or appreciated or loved HAD to be destroyed by him in order for him to WIN.

I was a slow learner but now that I’ve got it, I am not fooled by any attempt he makes to try to come back into my life. I know he didn’t miss me and regret anything. By my continuing to exist, he still has a target to destroy. So… I do my best to not remind him I exist. And to be happy when he has new targets to occupy his drive, his adversarial Drive, to dupe, to destroy, to WIN!

George Simon, two good books and two very very good, helpful websites.

Absolutely, my experience as well. My ex also counted as a win any time he could strike against me, even at the expense of our kids, or with the loss of basically all our money, that could have been used to benefit our kids as they grew up. But he did not care about that, only winning over me. And over anyone else.

Very interesting read.

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