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.