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Psychopathy: a Psychodynamic and Behavioral Model Central Annals of Neurodegenerative Disorders Bringing Excellence in Open Access Review Article *Corresponding author Samuel Juni, Department of Applied Psychology, New York University, USA, Tel: (212) 998-5548; Email: sam Psychopathy: A Psychodynamic Submitted: 14 November 2016 and Behavioral Model Accepted: 18 January 2017 Published: 20 January 2017a Samuel Juni* Copyright Department of Applied Psychology, New York University, USA © 2017 Juni OPEN ACCESS Abstract Keywords We are delighted that practitioners, theorists, and researchers have been following the clinical and diagnostic endeavors in psychopathology of our team at NYU. In a • Neuropsychiatry recent set of publications delineating specific aspects of character disorders (Juni 2009, • Neuropsychology 2009a, 2010, 2014), a comprehensive psychodynamic model of psychopathy has • Psychopathy been emerging as clinical findings led us to reconceptualize symptom clusters. I have been asked by the editor of this journal to share a unified model of psychopathy and antisocial behavior which incorporates our findings and conceptualizations. This paper is descriptive, intended to present an abridged summary of our conceptual system as it has evolved to date. The theoretical development and clinical rationales of the elements in this model are detailed in our previous papers. Grounded in our publications to date, the model is made more robust by incorporating the Oppositional Defiant factor and fine-tuning the other categories based on more recent clinical insights. Culling the conclusions from our clinical research studies, we annotate and outline the key elements of recent diagnostic and theoretical expositions of psychopathy, while elaborating and refining constructs of personality and behavioral disorders. The model is offered as a uniform classification strategy to systematize and reconcile disparate clinical and research data in the fields of neuropsychiatry, neuropsychology, personality, forensics, and social psychology. INTRODUCTION While psychopathy is often accompanied by antisocial behavior, the two phenomena are not equivalent. Psychopathy Psychopathic personality vs. Behavioral disorders is a disorder of personality. It may, or may not, be expressed in and controversial disorders of psychopathology [1]. The term has specific behavior patterns, and negative behavior – regardless beenPsychopathy further fractured has been by dualdescribed tracks as in one medicine of the mostand diagnostics ill-defined personality disorder (Footnote 1). of its intensity or pervasiveness – is insufficient evidence of a which focused inconsistently on psychodynamics and on overt Similarly, behaviors which are antisocial may be attributable behaviors. to causes other than psychopathy. This divergence has been The theoretical stance of this paper is not congruent with and clinical psychology, but has been steadily eroded by the the view of the antisocial personality disorder espoused in atheoreticalcommon sense transformation knowledge for decadesof American in the fieldspsychiatry of psychiatry into a the current version of the Diagnostic and Statistical Manual of behavioral-oriented discipline (evidenced in the gradual Mental Disorders [2]. Starting with the fourth edition in 2010, exorcising of psychodynamics in the progression of DSM DSM decided to substitute the term “antisocial” for the term editions) though the tide has been somewhat stemmed by the “psychopathic” in an effort to stress the behavioral, rather than valiant efforts of a consortium of psychoanalytic associations the dynamic, aspects of the disorder. This category is presented championing PDM. Ironically, DSM still uses the nomenclature of as a collection of behavioral anomalies which share antisocial Antisocial Personality Disorder though its elements are almost qualities – in a stark departure from the psychodynamic origins all circumscribed to habitual antisocial behavior. Psychopathy, of psychopathy postulated by Henderson [3] and Cleckley [4] and disorder and features traits and attributes that may – or may not –as engender defined conceptually antisocial behavior. in PDM, focuses primarily on personality fleshed out by Hare [5], and Meloy [6,7]. Our classification model of theWe Aggressive find the DSM Psychopath stance regarding elaborated behavioral in the Psychodynamic and antisocial disorders diagnostically unsound. By contrast, we find the criteria Our model is based on three postulates which differentiate between pathological personality factors and behavioral patterns as it retains the dynamic aspect of this disorder. Diagnostic Manual [8] to have a more sound definitional integrity Cite this article: Juni S (2017) Psychopathy: A Psychodynamic and Behavioral Model. Ann Neurodegener Dis 2(1): 1021. Juni (2017) Email: Central Bringing Excellence in Open Access as follows: if the behavior is offensive to others. Psychopathic Personality Disorder is intrapsychic, and its Impulse control deficit: Here, too, there is no evidence of diagnosis is not obviated by a lack of antisocial behaviors. • Its criteria are emotional rather than behavioral. delay and a diminished capacity to clamp down on impulse personality pathology. There is an inability to delay gratification any incipient impulses which may arise for them, including (for example)expression. sexuality, Thus, such appetite, individuals and thrill have seeking. difficulty Aggression controlling is but • Therefore,Antisocial Behaviordiagnosing patterns personality are typically disorders due in to general specific – an instance where control is lacking. While such individuals will anddeficits psychopathy in emotional in particularmodulation – basedand cognitive on overt anomalies. behavior express their aggression when frustrated, they have no particular is inappropriate. investment in belligerence, nor do they harbor an untoward DSM diagnostic criteria for Antisocial Personality degree of hostility or anti-social motivations. Disorder are primarily behavioral. As such, they are only Diagnostically, this pattern too is a behavioral style. It is • marginally relevant to Psychopathy. certainly not a personality disturbance, and has no implications The foundations of our conceptual strategy are anchored in of negative attitudes toward others. the differential seminal psychodynamic approaches of the classic Within the psychopathy category, we include the following: Oppositional defiant disorder: This is a new category we ourpsychopathy own studies. theoreticians Our system, -- Harepresented [5], Cleckley in Table [4], (1), and sorts Meloy the recently added to our model of psychopathy based on analyses various[6] -- as affective,elaborated relational, by elements and behavioralchampioned factors in DSM, into PDM, distinct and of patient protocols. categories which show minimal overlap. We demarcate between behavioral disorders and psychopathy. Within behavioral disorders, we feature the limitsTo thiscapture diagnosis the flavor to children of this distinct who defy psychopathic rules and regulations,orientation, following: arewe adapted deliberately the term contrary, Oppositional and show Defiant antisocial Disorder behaviors. from DSM. In DSM our use of the term, we recognize that some psychopathic adults have Social intelligence deficit: Many individuals are a characterological disposition to defy societal rules, authority and Psychopathy labels after inappropriate interpersonal psychiatrically and legally classified with Antisocial Behavior Tofigures, be sure, and wetheir accentuate regulations. the characterologicalWe postulate this aspects pattern of theto these people have no intention of acting inappropriately and disordercomprise (in a distinctaccordance motif with in thethe perspectiveclassification of ofPDM) psychopathy. instead of certainlyinteractions no negativeor running emotionality afoul of the which law. motivatesWe repeatedly them. find Instead, that focusing on the overt behavioral DSM markers. Developmentally, such individuals bring with them a thatthey thosesimply acts lack would sufficient be perceived social intelligence as negative to or understand hostile. the perceived history of mistreatment by powerful others which meaning or significance of their acts and do not anticipate the fact Characteristically, such “perpetrators” are genuinely and to adopt an oppositional attitude and a combative stance prompted their very personalities to coalesce around defiance, believe that it was all just a big “misunderstanding” (which it individuals, oppositionalism is an end of its own, divorced from, indeedpuzzled is, at since the troublethey lack they the findsocial themselves intelligence in, toand understand honestly andtoward unrelated any directives to, context by superiors or situational or authority features. figures. For these the perceived meaning and consequences of what they did). Their understanding of social repercussions of behavior is Normal healthy development is predicated on the limited, rendering their judgment dysfunctional. Behavior which internalization of cultural norms and mores. Reasonable deviates from accepted social mores is thus unwitting. We state prosocial external restrictions and behavioral mandates, though emphatically that not only can such activities not be considered initially experienced as dystonic, gradually get incorporated pathological, but they cannot even be considered antisocial, even not experience this transition, and continue to perceive norms Table 1: Factors of Antisocial Behavior and Psychopathy.
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