To date, no randomized controlled trial has compared
the outcomes of psychopathic individuals who do,
or do not, receive treatment. Moreover, no published
study has examined treatment programs developed
particularly for those with psychopathy; instead, treat-
ment for other conditions (mental disorder, substance
abuse, or recidivism risk) has been administered “as
usual” to those with psychopathy.
Nevertheless, a mounting body of recent quasi-
experimental evidence challenges the assumption that
individuals with psychopathy do not respond to con-
ventional treatment. This research suggests that psy-
chopathy, like many other personality disorders,
complicates the first-line treatment of mental and sub-
stance abuse disorders. Simply put, individuals with
psychopathy tend to have low treatment motivation, to
misbehave in treatment, and to respond more slowly
to treatment. However, when provided sufficient
“doses” of treatment, those with psychopathy are as
likely as anyone else to manifest reduced risk of vio-
lence and recidivism.
Three nonexhaustive examples will be provided
here. First, a meta-analysis of 44 studies indicated
that (a) therapeutic communities were the most com-
mon and least effective form of treatment for those
with psychopathy and (b) across treatment modalities
and definitions of psychopathy, treatment was moder-
ately successful in reducing recidivism for psycho-
pathic individuals (a 62% success rate). Second, a
prospective study of approximately 900 civil psychi-
atric patients indicated that psychopathy did not mod-
erate the effect of outpatient treatment on future
violence. Of those who received relatively intensive
treatment during one 10-week period, those with psy-
chopathic traits were as likely as those without such
traits to show significantly reduced violence potential
in the next 10-week period. Third, a prospective
study of 381 offenders mandated to substance abuse
treatment indicated that treatment involvement sig-
nificantly reduced risk of recidivism during the year
after release, regardless of the effect of psychopathic
traits. In the latter two studies, propensity scores were
applied to control for the nonrandom assignment of
individuals to less versus more intensive treatment.
The effects remained moderate and significant.
Together, this research suggests that individuals with
psychopathy should be recast as high-risk (not
hopeless) cases in need of intensive treatment.
Correctional research indicates that focusing inten-
sive resources on the highest-risk cases maximizes
reduction in recidivism.Basic Nature and
Manifestations of PsychopathyThe relatively recent surge of interest in applying
measures of psychopathy has affected our concep-
tualization of the construct itself. To be certain, use
of the PCL–R has advanced the field’s understand-
ing of the nature and manifestations of psychopa-
thy. The ever-increasing momentum of research on
psychopathy is largely attributable to the PCL–R’s
ability to assess reliably traits such as callousness,
facilitate comparison of results across studies, and
clarify communication among practitioners and
researchers. However, referring to the PCL–R as
the “gold standard of psychopathy” signals that the
field has mistakenly conflated a measurewith a
construct. A PCL–R score is no more psychopathy
than a Wechsler Adult Intelligence Scale (WAIS–R)
score is intelligence.
As research on the PCL–R’s utility in predicting
violence has accumulated, the dominant view
of psychopathy itself has shifted. Most modern
views of psychopathy may be traced to Hervey
Cleckley’s influential book The Mask of Sanity
(1941).Based on a series of case studies, Cleckley
articulated 16 criteria for psychopathy that empha-
sized traits of emotional detachment. Although the
PCL–R is based on Cleckley’s conceptualization, it
omits some features that Cleckley viewed as cen-
tral to psychopathy (e.g., low anxiety) and empha-
sizes tendencies toward violent and antisocial
behavior. Cleckley viewed these tendencies as
largely “independent” of the more fundamental
manifestations of psychopathy. As the field has
come to equate psychopathy with the PCL–R, there
has been slippage toward the notion that psychopa-
thy is a violent variant of antisocial personality dis-
order. Now, psychopaths are called “intraspecies
predators,” and criminal behavior has been held
up as the “ultimate criterion” for measures of
psychopathy.
Notably, this entry focuses on the nature and man-
ifestations of psychopathy among those for whom
measures of psychopathy are best validated: adult,
Caucasian, male offenders. Questions have been
raised about the applicability of the psychopathy
construct to juveniles, African Americans (who do
not manifest some deficits on laboratory tasks
thought prototypic of psychopathy), and women
(who do not yield a clear factor structure for mea-
sures of psychopathy).644 ———PsychopathyP-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 644