Treatment of psychopathy: a conceptual and empirical review

Abstract

For decades, psychopathy has been thought to be untreatable. Yet, conceptualisations, and indeed its assessment, have deviated away from viewing the disorder as personality pathology towards a behavioural focus where the core underlying deficits in cognition and affect have been ignored. Interventions have followed suit leading to a premature discounting of the role of therapy in adjusting psychopathic traits. Design/methodology/approach: The review critically evaluates the conceptual and empirical evidence relevant to the treatment of psychopathy, deciphering components integral to the disorder that require intervention. Psychopathy is approached from a developmental perspective, with the review identifying several mechanisms thought to be responsible for precipitating and perpetuating its expression. Findings: There appears some utility in targeting psychopathy from multiple angles, addressing experiences of trauma, associated schemas and the underlying cognitive-affective dysfunction noted to give rise to psychopathic traits. A new model for treatment was proposed integrating these factors in the hope that this will encourage the design of effective interventions that will address the origins and underlying deficits of the disorder, rather than symptomology. Originality/value: The review encourages future research to consider the aetiology of psychopathy, with the aim of informing early intervention and containing the disorder whilst in its infancy, as well as addressing neurobiological dysfunction when most malleable.

Is Psychopathy a Dynamic Risk Factor? An Empirical Investigation of Changes in Psychopathic Personality Traits Over the Course of Correctional Treatment

“…Furthermore, these significant reductions were observed after around 18 months of treatment, indicating that these changes were rapid. These results are a logical addition to past research, considering that the treatment program utilized in the STF, while not specifically designed to treat psychopathy, presents a high-intensity, multimodal approach that is in line with many of the suggestions for effective treatments of incarcerated individuals with psychopathic personality traits and follows RNR principles (Andrews & Bonta, 2010;Lewis, 2018;Lösel, 1998;Olver, 2018). Specifically, elements of the utilized cognitive-behavioral therapy with percentages of psychodynamic psychotherapy and schema psychotherapy (Moosburner et al, 2022b) might have succeeded in enhancing the participants' critical thinking and victim awareness, thereby targeting their deficits in emotional understanding (Lösel, 1998), that are measured by the PCL-R.…”

“…It is possible that the few participants who showed reliable individual improvements remained in treatment longer than those who remained unchanged or even got worse on an individual level. This would imply that the duration of treatment could be an important factor to consider when analyzing the effectiveness of treating psychopathic personality traits (Lewis, 2018).…”

Anxiety Mediates the Link Between Psychopathy and Aggression in NGRI Acquittees

“…It has become widely accepted that treatment outcomes for psychopathic individuals are bleak (for review see Lewis, 2018). However, Thomson (2019) has argued that the immediate focus of psychopathy treatment should be on breaking the link between psychopathy and harmful behaviors (pp.…”

Physical Abuse Explains Sex Differences in the Link Between Psychopathy and Aggression

“…The interpersonal-affective features of psychopathy are notoriously difficult to treat (Lewis, 2018; Thomson, 2019), therefore, the aim of treatment is to help reduce how these traits negatively impact the individual and others around them. As Sewall and Olver (2018) state, “it is not illegal to be an unpleasant person, but it is clearly illegal to commit a violent sexual assault” (p. 2).…”

“…There has been little research to understand the associations of psychopathy with forms of aggression beyond physical aggression, such as indirect or verbal aggression. Furthermore, while psychopathy has been regarded as one of the most challenging disorders to treat (Lewis, 2018; Polaschek & Skeem, 2018), it may be possible for interventions to target the links between psychopathy and aggression to reduce the number of victims; thus, it is paramount for research to begin to explore the mechanisms behind psychopathy-related aggression, and if these mechanisms are sex-specific. Here, we propose that a potential sex-specific mechanism is exposure to physical abuse.…”