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"Os psicopatas sabem intelectualmente o que é imoral, eles simplesmente não têm um sentimento de imoralidade sobre isso." - Barbara Oakley

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Será que um indivíduo com as variantes genéticas associadas à psicopatia é capaz de controlar comportamentos psicopatas?

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Esta notícia da BBC News - Brasil fala de James Fallon, um investigador, neurocientista e professor de psiquiatria e comportamento humano da Universidade da Califórnia, Irvine (UCI), que analisou cérebros de criminosos violentos durante mais de 20 anos e que, ao comparar os cérebros desses criminosos com o seu, descobriu padrões de ativação cerebral idênticos, associados à ausência de empatia, moralidade e autocontrole. Após essa descoberta, recorreu a exames do seu ADN e descobriu que tinha alelos associados à ausência de empatia e comportamento agressivo e violento. Tanto a mãe de Fallon, quanto a sua esposa, sempre perceberam nele um lado carinhoso e afetuoso, mas também um lado sombrio e perverso. A mãe de Fallon disse que existiram casos de criminalidade nos antepassados do pai de Fallon (hereditariedade), mas que sempre tentou dar-lhe uma educação positiva, de forma a neutralizar as tendências negativas. A verdade é que Fallon, apesar de admitir ter traços comuns com os de um psicopata, nunca agrediu nem matou ninguém. Ele costumava achar que a genética era tudo, mas mudou a sua opinião quando deparado com a sua situação, admitindo que a genética pode ser modificada pelo meio ambiente. Fallon acabou por publicar um livro sobre isso, em 2013, o qual intitulou de The Psychopath Inside. Penso que podemos fazer a ligação deste assunto com algo que temos vindo a falar muito nas aulas - a influência que o meio (e.g., educação, experiências de vida) pode ter na expressão dos genes que possuímos, nomeadamente a psicopatia.

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Mônica Vasconcelos

Da BBC Brasil em Londres

Legenda da foto,

Neurocientista americano descobriu que tinha "cérebro de psicopata" ao estudar criminosos

Um neurocientista americano que fazia estudos com criminosos violentos descobriu, por acaso, que ele próprio tinha "cérebro de psicopata".

Casado e pai de três filhos, James Fallon, professor de psiquiatria e comportamento humano da University of California, Irvine (UCI), disse à BBC Brasil que a descoberta fez com que ele reavaliasse seus conceitos a respeito de quem era. E transformou suas convicções enquanto cientista.

A experiência de Fallon, descrita no livro The Psychopath Inside, teve grande repercussão na internet.

Comentando o caso, um neurologista ouvido pela BBC disse que estamos interpretando os conhecimentos gerados pela genética de maneira "perigosa".

"Os profissionais estão atribuindo importância excessiva para a carga genética de uma pessoa, como se isso, por si só, fosse capaz de determinar o futuro de um ser humano", disse Eduardo Mutarelli, professor do Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo (USP).

Para ele, a experiência de Fallon ajuda a reequilibrar o debate que contrapõe a influência da herança genética à do meio (nesse caso em particular, a influência civilizadora da família e da sociedade sobre o indivíduo).

Revelação Perturbadora

A descoberta de Fallon aconteceu em 2005, quando ele analisava tomografias de cérebros de assassinos em série na universidade. Ele queria ver se encontrava alguma relação entre os padrões anatômicos dos cérebros desses pacientes e seu comportamento.

Fallon explicou que, para ter uma base de comparação, tinha colocado na pilha tomografias de membros de sua própria família - a ideia era usá-los como modelos de cérebros "normais".

Ao chegar ao fim da pilha, onde estavam os exames de sua família, o cientista viu uma tomografia que mostrava um padrão claro de patologia. "O exame mostrava baixa atividade em certas áreas dos lobos frontal e temporal que estão associadas à empatia, moralidade e ao auto-controle".

Fallon contou que, no começo, pensou que fosse um engano. Mas feitas as checagens, o neurocientista, que estudava psicopatas há mais de duas décadas, viu-se às voltas com uma realidade um tanto quanto incômoda: o cérebro representado naquele exame era seu.

"As mesmas áreas do cérebro estavam completamente apagadas, como nos piores casos que eu tinha visto", disse Fallon.

Para se certificar, Fallon fez mais algunas investigações.

Exames do seu DNA confirmaram que ele tinha genes alelos associados à ausência de empatia e comportamento agressivo e violento.

Fallon também se submeteu a um teste usado por muitos pesquisadores e psicólogos para avaliar tendências antisociais e psicopáticas, a Robert Hare Checklist.

"Psicopatas alcançam acima de 30 pontos no teste de Robert Hare", disse Fallon. "A pontuação máxima é 40. Eu alcanço 18, 20 ou 22. Tenho vários traços em comum com psicopatas, só não sou criminoso. Nunca matei nem estuprei ninguém e prefiro vencer uma discussão com argumentos do que com força física", diz.

Legenda da foto,

Análise mostrou que cérebro de Fallon tinha traços em comum com psicopatas

Fallon contou que quando compartilhou suas descobertas com a família e com amigos, eles não se surpreenderam. Gradualmente, o neurologista começou a se ver do ponto de vista das pessoas que o conheciam bem.

"Tive várias conversas reveladoras com minha mãe. Ela me disse que sempre percebeu um lado sombrio em mim e tomava cuidado especial para neutralizar essas tendências e incentivar outras, mais positivas", conta.

Nessas conversas, a mãe também contou ao filho que vários antepassados dele pelo lado paterno tinham sido criminosos temidos. Entre eles, Lizzie Borden, acusada de matar o pai e a madrasta em 1892.

Para a esposa, era como se existissem dois James Fallon convivendo num único homem.

"Sou casada com duas pessoas, uma é inteligente, engraçada e afetuosa. A outra é um sujeito perverso, de quem eu não gosto", disse a mulher do neurologista em uma entrevista para a TV.

"Tenho muito jeito para lidar com estranhos, faço muita caridade. Mas sou uma decepção como marido. Posso ver um bebê que não conheço e ficar com os olhos cheios de lágrimas, mas não sinto uma conexão emocional profunda com minha própria família", diz.

Fallon descreveu alguns dos traços típicos de um psicopata: "Psicopatas possuem um narcisismo agressivo, charme, desenvoltura aliada a superficialidade, senso de superioridade, tendência a manipular, são emocionalmente rasos, não sentem culpa, remorso ou vergonha".

"Podem ser magnânimos e generosos, mas são emocionalmente frios", afirma.

Teria Hitler, por exemplo, sido um psicopata?

"Não. Hitler era capaz de sentir empatia pelas pessoas e tinha relacionamentos próximos, então eu diria que ele não era um psicopata. Já Stalin, por exemplo, tenho quase certeza de que sim. Ele não era próximo nem dos próprios filhos", observa.

"A capacidade - ou não - de sentir empatia é essencial para se establecer se uma pessoa é um psicopata", diz o neurologista.

Amor de Mãe

James Fallon diz não ter dúvidas de que foi o amor da família que impediu que ele realizasse seu "potencial" e se tornasse um criminoso violento.

"Sou uma pessoa agressiva e vingativa, gosto de manipular as pessoas, sinto prazer no poder. Mas todos foram tão amorosos comigo, tenho uma mãe afetuosa e uma esposa maravilhosa", afirma.

"Além disso, não tive experiências de abandono, abuso ou traumas violentos na infância. Tudo isso neutralizou minha biologia", relata.

O neurologista confessou que não teria feito essa afirmação cinco anos antes. "Eu costumava achar que a genética era tudo. Hoje, estou convencido de que a biologia é importante, mas a genética pode ser modificada pelo meio ambiente", diz.

Gene X Meio

Legenda da foto,

Para Fallon, descoberta lhe mostrou importância do ambiente sobre o desenvolvimento pessoal

As revelações de James Fallon, descritas no seu livro e em palestras - algumas disponíveis na internet - revivem um debate que há muito intriga especialistas: somos produto da nossa herança genética ou do meio em que vivemos?

Para o neurologista da USP e do Hospital Sírio Libanês Eduardo Mutarelli, o caso de Fallon reforça o papel da sociedade (ou seja, do meio) na formação do indivíduo. E ajuda a combater uma certa tendência "determinista" na forma como nosso potencial genético vem sendo interpretado por médicos hoje.

"A genética hoje trabalha muito com probabilidades, com potencial genético e fatores de risco", disse Mutarelli.

O médico citou como exemplo doenças como o Mal de Alzheimer ou o Mal Parkinson.

"Com o conhecimento atual, sabemos que existe uma certa carga genética associada a essas doenças. Mas você carrega um certo fator de risco e isso vai se transformar em doença caso outras coisas contribuam para isso", explicou.

"Você não se cuida, não come direito, esses são fatores de risco para que a pessoa venha a desenvolver a doença", observa.

Mas trazendo a discussão de volta para o caso de James Fallon, Mutarelli faz uma ressalva: "No caso dele, se ele tem um exame de imagem de cérebro que é igual ao de um psicopata, ele só não é psicopata porque foi bem educado".

"O lobo frontal está desregulado, a alteração existe na experiência dele e a ressonância mostra a alteração, ou seja o gene foi ativado. Ele só não é um serial killer por causa da família", reforçou o professor.

E concluindo: "O jeito de mudar o mundo é educando".

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Pesquisador se descobre psicopata ao analisar o próprio cérebro - BBC News Brasil

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Mônica Vasconcelos Da BBC Brasil em Londres Um neurocientista americano que fazia estudos com criminosos violentos descobriu, por acaso, que ele próprio tinha "cérebro de psicopata". Casado e pai de três filhos, James Fallon, professor de psiquiatria e comportamento humano da University of California, Irvine (UCI), disse à BBC Brasil que a descoberta fez com que ele reavaliasse seus conceitos a respeito de quem era.

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Hoje, acredita-se que a causa da psicopatia possa ser uma combinação de fatores genéticos e fatores ambientais. Poderá o indivíduo com as variantes genéticas associadas à psicopatia controlar comportamentos psicopatas?

Segundo o psiquiatra Fernando Fernandes, o psicopata tem consciência moral. Contudo, “essa consciência moral não é internalizada nos seus sentimentos e emoções”. Isto é, o psicopata tem consciência de que é errado causar dor ao outro, mas, mesmo assim, age de forma a concretizar isso, uma vez que tais ações não surtem efeito sobre os seus sentimentos e emoções. O psicopata não sofre nem sente culpa por magoar o outro.

Já no século XX, o psicólogo Hervey Cleckley falou do termo “Psicopatia”, associando-lhe o conceito de “demência semântica”. Segundo o autor, esta caracteriza-se por “um défice na compreensão dos sentimentos em profundidade”, apesar destes pacientes manifestarem uma compreensão parcial dos comportamentos. Cleckley referiu ainda que “o psicopata compreende parcialmente o termo “amor”, mas não consegue vivenciá-lo como nós vivenciamos”.

Dado isto, há duas características que o psicólogo verificou nas 15 pessoas com “demência semântica” por ele analisadas:

- Ausência de culpa e empatia;

- Ausência de ligação emocional com as outras pessoas.

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O Impacto dos Fatores Genéticos e Ambientais no Desenvolvimento da Psicopatia

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O Impacto dos Fatores Genéticos e Ambientais no Desenvolvimento da Psicopatia

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Este é apenas o asbtract do artigo em questão, mas parece-nos muito interessante, para quem tiver a possibilidade de aceder ao artigo completo.

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O Impacto dos Fatores Genéticos e Ambientais no Desenvolvimento da Psicopatia

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Psicopatia e Sociopatia: uma Revisão de Literatura

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Psicopatia e Sociopatia: uma Revisão de Literatura

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Psicopatia e Sociopatia (uma Revisão de Literatura)

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Personalidade ou Personalidades Psicopáticas? Explorar Potenciais Variantes de Psicopatia e as suas Implicações para a Avaliação de Risco

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Personalidade ou Personalidades Psicopáticas? Explorar Potenciais Variantes de Psicopatia e as suas Implicações para a Avaliação de Risco

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Psychopathic personality or personalitiesExploring potential variants of psychopathyand their implications for risk assessment

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Será que um indivíduo com as variantes genéticas associadas à psicopatia é capaz de controlar comportamentos psicopatas?

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Será que um indivíduo com as variantes genéticas associadas à psicopatia é capaz de controlar comportamentos psicopatas?

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Quando nos deparamos com uma questão destas, perguntamos a nós mesmos: o que causa a psicopatia num indivíduo? Na realidade, não há uma causa específica para a psicopatia, pois esta varia entre uma combinação de fatores genéticos e ambientais.

Abordando as questões genéticas, não existe um gene chamado de “gene psicopata” que determine que os indíviduos que o possuem padecerão, com certeza, de psicopatia. Não, isso é uma ideia errada. O que nós sabemos é que existem variantes genéticas associadas a comportamentos de psicopatia que influenciam o funcionamento do cérebro. Portanto, a conclusão que se tira é que ninguém nasce um psicopata, porém os indivíduos que possuem esse(s) gene(s) associados à psicopatia podem ter um maior risco de a desenvolver.

Os fatores ambientais podem contribuir para aumentar ou reduzir a probabilidade de um indivíduo desenvolver psicopatia, apesar de estes terem pouco impacto em relação aos fatores genéticos. Coisas como fumar ou ter níveis altos de stress durante uma gravidez podem ser prejudiciais para a saúde e aumentar o risco de psicopatia no bebé. Outro aspeto que é muito importante referir é que os pais (de um indivíduo em questão) têm um papel muito importante no desenvolvimento do(s) filho(s), pois estes têm uma grande responsabilidade sobre o ambiente onde o filho cresce. E, como dito anteriormente, apesar da psicopatia ter uma maior influência de fatores genéticos do que ambientais, as experiências de um indivíduo durante a sua infância podem influenciar a sua probabilidade de se tornar (ou não) um potencial psicopata no futuro.

É importante apontar que os fatores genéticos e ambientais não causam a psicopatia diretamente, em vez disso, eles têm influência sobre a estrutura e funcionamento do cérebro, o que aumenta o risco de uma pessoa desenvolver psicopatia.

Em conclusão, os genes não determinam completamente o nosso comportamento, eles simplesmente dão-nos potencial para nos tornarmos numa pessoa com características específicas. Um indivíduo com variantes genéticas associadas à psicopatia tem, igualmente, a capacidade de tomar as suas próprias decisões e definir o seu próprio futuro. Respondendo à nossa questão de investigação, podemos, então, concluir que um indivíduo com as variantes genéticas associadas à psicopatia não manifestará, necessariamente, comportamentos psicopatas.

“Your genes are not totally deterministic of who you are. Genes simply give you a potential. People still make their own choices and have agency in shaping who they become.” - Amanda Ramos

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"Uma característica marcante do transtorno dos psicopatas é que eles não se incomodam com muita coisa. Eles não ruminam e não ficam deprimidos." - Kent A. Kiehl

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Transtornos de Personalidade Psicopática e Antissocial: Tratamento e Questões de Pesquisa

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Transtornos de Personalidade Psicopática e Antissocial: Tratamento e Questões de Pesquisa

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Psychopathic and Antisocial Personality Disorders, Treatment and Research Issues

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Volume de Substância Cinzenta Pré-Frontal Reduzido e Atividade Autonómica Reduzida no Transtorno de Personalidade Antissocial

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Volume de Substância Cinzenta Pré-Frontal Reduzido e Atividade Autonómica Reduzida no Transtorno de Personalidade Antissocial

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Reduced Prefrontal Gray Matter Volume and Reduced Autonomic Activity in Antisocial Personality Disorder

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É assim que a vida normal é sentida por um psicopata

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É assim que a vida normal é sentida por um psicopata

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Everyday, nonviolent psychopaths say they're nothing like the psychopath we see on our movie screens

Illustration by Jessica Siao

Not so long ago, a woman was sitting on a plane, minding her own business, when the man next to her made several attempts at conversation. Jane, let's call her, assumed the man was drunk, so she didn't bother being...

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This Is How Normal Life Feels as a Psychopath

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Not so long ago, a woman was sitting on a plane, minding her own business, when the man next to her made several attempts at conversation. Jane, let's call her, assumed the man was drunk, so she didn't bother being...

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Esta é uma pergunta que algumas pessoas fazem a si próprias. Este teste de psicopatia é usado para avaliar a presença de psicopatia em indivíduos com mais de 18 anos. No entanto, os resultados deste teste de psicopatia NÃO devem ser interpretados como um diagnóstico formal. Isso só pode ser feito por um médico qualificado ou profissional de saúde mental. Num ambiente profissional, a avaliação da psicopatia contém duas partes: uma entrevista semiestruturada e uma revisão do prontuário e do histórico do sujeito.

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Psychopath Test. Am I A Psychopath? | HealthyPlace

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Take this psychopath test to help answer the question, Am I a psychopath? The online psychopath test is 20 questions, instantly scored.

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Esta secção é dedicada àqueles que desejam aprofundar ainda mais o seu conhecimento acerca desta temática.

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Psicopatia: Definição, Sintomas, Sinais e Causas

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Psicopatia: Definição, Sintomas, Sinais e Causas

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The definition of a psychopath and causes of psychopathy are sometimes argued about in scientific circles, but understanding the symptoms and signs of a psychopath is possible. Psychopathy causes may include genetics and early life factors and the signs and symptoms of a psychopath are typically noticeable before a psychopath's 16th birthday as these symptoms are thought to be fairly stable across the lifetime. Learn more about psychopathy below.

Definition of Psychopathy

The definition of psychopathy can be challenging as depending on the researcher, psychopathy is defined slightly differently and often many psychopathic traits are taken into account. That said, a simple definition of psychopathy is provided by the Society for the Scientific Study of Psychopathy. Psychopathy is:

"A constellation of traits that comprises affective features, interpersonal features, as well as impulsive and antisocial behaviors. The affective features include lack of guilt, empathy, and deep emotional attachments to others; the interpersonal features include narcissism and superficial charm; and the impulsive and antisocial behaviors include dishonesty, manipulativeness, and reckless risk-taking. Although psychopathy is a risk factor for physical aggression, it is by no means synonymous with it. In contrast to individuals with psychotic disorders, most psychopaths are in touch with reality and seemingly rational. Psychopathic individuals are found at elevated rates in prisons and jails, but can be found in community settings as well."

Causes of Psychopathy

No one knows exactly what causes psychopathy but it is likely a combination of genetics, environmental and interpersonal factors. For example, children of psychopaths are more likely to be psychopaths themselves, suggesting genetic influence.

Additionally, some early life experiences have been shown to increase the risks of becoming a psychopath. Poor parenting, parenting that focuses on punishment (rather than rewards) and inconsistent parenting appear to help cause psychopathy. Additional risk factors for psychopathy include:

Substance abuse by the parents

Separation from a parent or lack of parental involvement

Child physical abuse or neglect

Signs and Symptoms of Psychopathy

The signs and symptoms of psychopathy are identified most commonly in scientific studies by Hare's 20-item Psychopathy Checklist-Revised. This checklist identifies the following as the symptoms and signs of psychopathy:

1. Superficial charm and glibness

2. Inflated sense of self-worth

3. Constant need for stimulation

4. Lying pathologically

5. Conning others; being manipulative

6. Lack of remorse or guilt

7. Shallow emotions

8. Callousness; lack of empathy

9. Using others (a parasitic lifestyle)

10. Poor control over behavior

11. Promiscuous sexual behavior

12. Behavioral problems early in life

13. Lack of realistic, long-term goals

14. Being impulsive

15. Being irresponsible

16. Blaming others and refusing to accept responsibility

17. Having several marital relationships

18. Delinquency when young

19. Revocation of conditional release

20. Criminal acts in several realms (criminal versatility)

Is Psychopathy a Mental Illness?

Psychopathy is also sometimes known as psychopathic personality disorder and is considered a mental illness. As with mental illness in general, there is no known cure for psychopathy and treatment of adult psychopaths has been shown ineffective. However, the treatment of children with psychopathic traits has shown some promise.

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Psychopathy: Definition, Symptoms, Signs and Causes

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The definition of a psychopath and causes of psychopathy are sometimes argued about in scientific circles, but understanding the symptoms and signs of a psychopath is possible. Psychopathy causes may include genetics and early life factors and the signs and symptoms of a psychopath are typically noticeable before a psychopath's 16th birthday as these symptoms are thought to be fairly stable across the lifetime.

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Traços e Características de um Psicopata

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Traços e Características de um Psicopata

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There are many traits and characteristics of psychopaths. While psychopaths are individuals, they share many aspects of their personalities. The Hare Psychopath Checklist-Revised (PCL-R) outlines 20 characteristics of a psychopath categorized into four validated factors.

Interpersonal Traits of a Psychopath

Perhaps the most well-known interpersonal trait of a psychopath is their pathological lying. Psychopaths lie constantly to cover up their psychopathic traits and antisocial (often illegal) behaviors.

Other interpersonal characteristics of a psychopath include:

Glibness and superficial charm

Grandiose sense of self-worth

Being conning and manipulative

Affective or Emotional Characteristics of a Psychopath

Of course, the emotions of a psychopath also have specific traits. One such emotional characteristic is the lack of remorse or guilt. This psychopath emotional characteristic explains why psychopathic killers can commit heinous acts such as murder and not feel bad about them.

Other affective psychopathic characteristics include:

Shallow emotions (emotions may be felt but in shallow and fleeting ways)

Callousness and lack of empathy

Failure to accept responsibility for own acts

Lifestyle Psychopathic Traits

Not only can psychopathic traits be seen in the emotions and interpersonal aspects but they can also be seen in the lifestyles of psychopaths as well. One such lifestyle trait is a parasitic lifestyle where the psychopath uses and feeds off of others. He or she likely does this by utilizing the interpersonal traits noted above.

Other lifestyle psychopathic traits include:

A need for stimulation

A lack of realistic, long-term goals

Impulsivity

Irresponsibility

Antisocial Traits of Psychopaths

Antisocial traits of psychopaths are traits that go against society's conventions. For example, juvenile delinquency and early behavioral problems are antisocial traits that many psychopaths have. These severe problems leave parents wondering, " Is my child a psychopath?"

Other antisocial traits of a psychopath include:

Poor behavior controls

Revocation of conditional release (i.e. a revoking of parole)

Criminal versatility (i.e. where a psychopath is active in multiple types of crime)

Other Psychopathic Characteristics

Not all 20 checklist items on the PCL-R fit neatly into these factors. Additional psychopathic characteristics include:

Promiscuous sexual behavior

Many marital relationships

When Looking at Psychopathic Traits and Characteristics

When looking at a person and assessing psychopathic traits and characteristics, the PCL-R scores each item as a 0, 1 or 2 for how well each checklist item fits the person. That means that if these psychopathic traits only fit an individual somewhat, they likely aren't a psychopath even though they may share traits with one. The highest possible score on the checklist is a 40 and psychopaths score 30 or above. An average non-psychopathic criminal scores a 22 while a non-psychopathic, non-criminal scores about a 2. Essentially this indicates that many people do have several psychopathic characteristics but that doesn't make them a psychopath - only a preponderance of severe psychopathic traits does.

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Psychopathic Traits and Characteristics of a Psychopath

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There are many traits and characteristics of psychopaths. While psychopaths are individuals, they share many aspects of their personalities. The Hare Psychopath Checklist-Revised (PCL-R) outlines 20 characteristics of a psychopath categorized into four validated factors. Perhaps the most well-known interpersonal trait of a psychopath is their pathological lying.

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Understanding that psychopaths are some of society's most dangerous people and that most commit crimes - often violent crimes - it is important to ask, is there a treatment for psychopaths? And if treatment for psychopaths exist, what is it and how successful is it? These are questions that researchers have been working on for decades and only now are we starting to answer the question of whether the psychopath can be cured.

Traditional Thought on the Treatment of Psychopaths

The traditional view on the treatment of psychopaths is that treatment just doesn't work. Study after study has shown that the behaviors of the psychopath do not change in response to psychoanalysis, group therapy, client-centered therapy, psychodrama, psychosurgery, electroconvulsive therapy (ECT) or drug therapy. In fact, in one very disturbing study in 1991, those psychopath inmates who were a part of group therapy actually had a higher violent recidivism rate than those psychopaths who received no therapy. As one psychopath put it, "These programs are like a finishing school. They teach you how to put the squeeze on people." (20 Signs You're With A Psychopath or You Are A Psychopath) It should be noted that the scientific rigor in these studies was far less than desirable and while it all points to one conclusion, due to the errors in methods, there may still be lessons to be learned in an adult psychopathic population with regards to treatment.

Treatment of Juvenile Psychopaths

There is hope for curing psychopaths, however, and that comes in the form of the treatment of juveniles with psychopathic tendencies (" child psychopaths" - psychopathy can't formally be diagnosed until adulthood). In this population, a treatment that is a conglomeration of other theories and practices called "decompression treatment," has been used with some success.

Initially, in 2001, decompression treatment was tried in a small number of children with psychopathic behaviors (10 received decompression treatment, 10 received group therapy, 10 received no therapy). In the two year follow-up period:

70% of the no therapy group had been rearrested

20% of the group receiving group therapy had been rearrested

10% of the group receiving decompression treatment had been rearrested

While these numbers were promising, the study size was very small.

The next, larger, study followed 248 incarcerated boys all considered to be "unmanageable" for 54 months (4.5 years) with 40% of them receiving decompression treatment, the rest receiving group therapy. In this study, again, the results were positive:

* The recidivism rate in the decompression group was only 56% as compared to 78% for those receiving traditional group therapy.
* The violent recidivism rate dropped to 18% as compared to 36%.

Additional study has seen similar results and shown that decompression treatment is highly effective in reducing institutional misconduct and recidivism.

However, the issue with decompression therapy is that in order for it to be successful, it must be applied for a very long period of time and this is part of the reason for the lengths of these studies. It appears that short-term decompression treatment is not effective but this treatment used for up to and over a year, is effective, particularly in those with less severe psychopathic tendencies.

The Costs of Psychopath Treatment

Of course, any treatment that lasts up to and beyond a year is very expensive, however, the cost of criminals getting out of prison only to re-offend (recidivism) is even higher. In the computations done by the study, The Criminal Psychopath: History, Neuroscience, Treatment, and Economics, using conservative treatment effectiveness numbers, it found that if decompression treatment were to be given to just half of all incarcerated juvenile psychopaths, the savings would be $115 billion per year. And, of course, there are additional savings that cannot be measured - that of human lives.

So it seems that while a 100% cure for psychopathy has not been found, an effective treatment in the psychopath juvenile population has been.

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Treatment for Psychopaths: Can the Psychopath Be Cured?

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Understanding that psychopaths are some of society's most dangerous people and that most commit crimes - often violent crimes - it is important to ask, is there a treatment for psychopaths? And if treatment for psychopaths exist, what is it and how successful is it?

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Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility, among others. 1,2 As a consequence of these criteria, the image of the psychopath is that of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy?

Like healthy people, many psychopaths love their parents, spouse, children, and pets in their own way, but they have difficulty in loving and trusting the rest of the world. Furthermore, psychopaths suffer emotionally as a consequence of separation, divorce, death of a beloved person, or dissatisfaction with their own deviant behavior. ³
Sources of Sadness
Psychopaths can suffer emotional pain for a variety of reasons. As with anyone else, psychopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, because it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Psychopaths are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most psychopaths are devoid of a stable social network or warm, close bonds.

The life histories of psychopaths are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods. ⁴ These persons may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, psychopaths feel inferior to others and know they are stigmatized by their own behavior. Some psychopaths are superficially adapted to their environment and are even popular, but they feel they must carefully hide their true nature because it will not be acceptable to others. This leaves psychopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never be part of it.

Psychopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment because of conflicts with others and unrealistic expectations. Furthermore, many psychopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating, and depressing confrontations, including trouble with the justice system.

As psychopaths age, they are not able to continue their energy-consuming lifestyle and become burned-out and depressed while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.
Emotional Pain and Violence
Social isolation, loneliness, and associated emotional pain in psychopaths may precede violent criminal acts. ⁵ They believe that the whole world is against them and eventually become convinced that they deserve special privileges or rights to satisfy their desires. As psychopathic serial killers Jeffrey Dahmer and Dennis Nilsen expressed, violent psychopaths ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently, their sadness and suffering increase, and their crimes become more and more bizarre. ⁶

Dahmer and Nilsen have stated that they killed simply for company. ⁵ Both men had no friends and their only social contacts were occasional encounters in homosexual bars. Nilsen watched television and talked for hours with the dead bodies of his victims; Dahmer consumed parts of his victims' bodies in order to become one with them: he believed that in this way his victims lived further in his body. ⁶

For the rest of us, it is unimaginable that these men were so lonely-yet they describe their loneliness and social failures as unbearably painful. Each created his own sadistic universe to avenge his experiences of rejection, abuse, humiliation, neglect, and emotional suffering.

Dahmer and Nilsen claimed that they did not enjoy the killing act itself. Dahmer tried to make zombies of his victims by injecting acid into their brains after he had numbed them with sleeping pills. He wanted complete control over his victims, but when that failed, he killed them. Nilsen felt much more comfortable with dead bodies than with living people-the dead could not leave him. He wrote poems and spoke tender words to the dead bodies, using them as long as possible for company. In other violent psychopaths, a relationship has been found between the intensity of sadness and loneliness and the degree of violence, recklessness, and impulsivity. 5,6
Self-Destruction
Violent psychopaths are at high risk for targeting their aggression toward themselves as much as toward others. A considerable number of psychopaths die a violent death a relatively short time after discharge from forensic psychiatric treatment as a result of their own behavior (for instance, as a consequence of risky driving or involvement in dangerous situations). ⁷ Psychopaths may feel that all life is worthless, including their own. 3,5,6
Treatment
In the past decade, neurobiological explanations have become available for many of the traits of psychopathy. For example, impulsivity, recklessness/irresponsibility, hostility, and aggressiveness may be determined by abnormal levels of neurochemicals, including monoamine oxidase (MAO), serotonin and 5-hydroxyindoleacetic acid, triiodothyronine, free thyroxine, testosterone, cortisol, adrenocorticotropic hormone, and hormones of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes. ⁸

Other features, such as sensation-seeking and an incapacity to learn from experiences, might be linked to cortical underarousal. ⁴ Sensation-seeking could also be related to low levels of MAO and cortisol and high concentrations of gonadal hormones, as well as reduced prefrontal gray matter volume.9 Many psychopaths can thus be considered, at least to some degree, victims of neurobiologically determined behavioral abnormalities that, in turn, create a fixed gulf between them and the rest of the world.

It may be possible to diminish traits such as sensation-seeking, impulsivity, aggression, and related emotional pain with the help of psychotherapy, psychopharmacotherapy, and/or neurofeedback. Long-term psychotherapy (at least 5 years) seems effective in some categories of psychopaths, in so far as psychopathic personality traits may diminish. ¹⁰⁻¹²

Psychotherapy alone may be insufficient to improve symptoms. Psychopharmacotherapy may help normalize neurobiological functions and related behavior/personality traits. ¹³ Lithium is impressive in treating antisocial, aggressive, and assaultive behavior. ¹⁴ Hollander ¹⁵ found that mood stabilizers, such as divalproex, SSRIs, MAOIs, and neuroleptics, have documented efficacy in treating aggression and affective instability in impulsive patients. There have been no controlled studies of psychopharmacotherapy for other core features of psychopathy.

Cortical underarousal and low autonomic activity-reactivity can be substantially reduced with the help of adaptive neurofeedback techniques. 16,17
CASE VIGNETTE
Norman was raised by his aunt; his parents were divorced and neither was capable of or interested in caring for him. As a child and adolescent, he had numerous encounters with law enforcement for joyriding, theft, burglary, fraud, and assault and battery. He was sent to reform school twice. When he was 21, he was convicted of armed robbery and served 1½ years in jail. His only close friend was another violent criminal; he had many short-term relationships with girlfriends. At 29, he killed two strangers in a bar who had insulted him and was sentenced to forensic psychiatric treatment. The diagnosis was psychopathy, according to Hare's psychopathy checklist. ²

Norman showed little improvement over the course of 7 years of behavioral psychotherapy and became less and less motivated. The staff of the forensic psychiatric hospital considered him untreatable and intended to stop all treatment attempts. Norman's lawyer arranged for an examination by a forensic neurologist, who subsequently found that Norman suffered from severe cortical underarousal, serotonin and MAO abnormalities, and concentration problems.

Treatment with D,L-fenfluramine, a serotonin-releasing drug, was started. (Fenfluramine was voluntarily withdrawn from the US market in 1997.) Acute challenge doses (0.2 mg/kg to 0.4 mg/kg) produced significant dose-dependent decreases in impulsive and aggressive responses. After 1 month, an MAOI (pargyline, 10 mg/kg) and psychodynamic psychotherapy were added. Pargyline produced some normalization of his EEG pattern and was titrated to 20 mg/kg over 5 months. Neurofeedback was started after 2 months and continued for 15 months. His EEG pattern gradually normalized, and his capacity for concentration and attention increased.

Norman continued to receive D,L-fenfluramine and psychotherapy for 2 years, at which point he was discharged from forensic treatment. He voluntarily continued psychotherapy for an additional 3 years and, in the 4 years since his release, has not reoffended.
Conclusions
It is extremely important to recognize hidden suffering, loneliness, and lack of self-esteem as risk factors for violent, criminal behavior in psychopaths. Studying the statements of violent criminal psychopaths sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacotherapy, neurofeedback, and combined psychotherapy research is needed to prevent and treat psychopathic behavior.

The current picture of the psychopath is incomplete because emotional suffering and loneliness are ignored. When these aspects are considered, our conception of the psychopath goes beyond the heartless and becomes more human.

Note to readers- This article was originally published in Psychiatric Times and posted on PsychiatricTimes.com in 2006. Ever since, it has remained one of the best-read articles. We re-publish it here with updates from Dr Martens.

Disclosures:
Dr Martens is Chair of the W. Kahn Institute of Theoretical Psychiatry and Neuroscience. He is also Psychiatry Advisor of the European Commission (Leonardo da Vinci) and a member of the Royal College of Psychiatrists. References
1. Cleckley HM. Mask of Sanity: An Attempt to Clarify Some Issues About the So-Called Psychopathic Personality. 6th ed. St Louis: CV Mosby Co; 1982.

2. Hare RD, Harpur TJ, Hakstian AR, et al. The revised psychopathy checklist: descriptive statistics, reliability, and factor structure. Psychol Assess. 1990;2:338-341.

3. Martens W. Hidden suffering of the psychopath: new insight on basis of self-reports of psychopaths; 2013. Accessed September 15, 2014. https://www.smashwords.com/books/view/304901

4. Martens WHJ. Antisocial and psychopathic personality disorders: causes, course and remission: a review article. Int J Offender Ther Comp Criminol. 2000;44:406-430.

5. Martens WH, Palermo GB. Loneliness and associated violent antisocial behavior: analysis of the case reports of Jeffrey Dahmer and Dennis Nilsen. Int J Offender Ther Comp Criminol. 2005;49:298-307.

6. Martens WH. Sadism linked to loneliness: psychodynamic dimensions of the sadistic serial killer Jeffrey Dahmer. Psychoanal Rev. 2011;98:493-514.

7. Black DW, Baumgard CH, Bell SE, Kao C. Death rates in 71 men with antisocial personality disorder: a comparison with general population mortality. Psychosomatics. 1996;37:131-136.

8. Martens WHJ. A new multidimensional model of antisocial personality disorder. Am J Forensic Psychiatry. 2005;25:59-73.

9. Raine A, Lencz T, Bihrle S, et al. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry. 2000;57:119-127.

10. Dolan B, Coid J. Psychopathic and Antisocial Personality Disorders: Treatment and Research Issues. London: Gaskell; 1993.

11. Dolan B. Therapeutic community treatment for severe personality disorders. In: Millon T, Simonsen E, Birket-Smith M, Davis RD, eds. Psychopathy: Antisocial, Criminal, and Violent Behaviors. New York: Guilford Press; 1998:407-438.

12. Sanislow CA, McGlashan TH. Treatment outcome of personality disorders. Can J Psychiatry. 1998;43:237-250.

13. Martens WH. Criminality and moral dysfunctions: neurologic, biochemical and genetic dimensions. Int J Offender Ther Comp Criminol. 2002;46:170-182.

14. Bloom FE, Kupfer DJ, eds. Psychopharmacology: The Fourth Generation of Progress. New York: Raven Press; 1994.

15. Hollander E. Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder. J Clin Psychiatry. 1999;60(suppl 15):38-44.

16. Martens WH. Effects of antisocial or social attitudes on neurobiological functions. Med Hypotheses. 2001;56:664-671.

17. Raine A. Autonomic nervous system factors underlying disinhibited, antisocial, and violent behavior. Biosocial perspectives and treatment implications. Ann N Y Acad Sci. 1996;794:46-59.

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Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility, among others.

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"Um psicopata pode dizer o que tu estás a pensar, mas o que ele não faz é sentir o que tu sentes. São pessoas sem consciência." - Robert D. Hare

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"Apesar da falta de consciência do psicopata e da falta de empatia pelos outros, ele é inevitavelmente melhor em enganar as pessoas do que qualquer outro tipo de ofensor." - Anna Salter

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"Eu comento regularmente o meu desejo de explorar os meus admiradores ou matar bebés e animais fofos, e nem preciso rir ou sorrir para as pessoas pensarem que estou a brincar." - M. E. Thomas

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"Um psicopata pode usar uma palavra como «eu amo-te», mas isso não significa nada mais para ele do que se ele dissesse: “Vou tomar uma chávena de café”. - Robert D. Hare

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- Alelos

- Ambiente

- Correlação

- Doença psiquiátrica

- Estudos de adoção

- Estudos de associação do genoma completo (GWAS)

- Estudos de associação genética de genes candidatos

- Estudos de epidemiologia genética

- Estudos de ligação genética

- Estudos de gémeos

- Fenótipo

- Gémeos dizigóticos

- Gémeos monozigóticos

- Genética

- Genótipo

- Variantes genéticas

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Um grupo de psiquiatras visualizou, num período de 3 anos, 400 filmes com personagens que poderiam ser descritas como psicopatas. Isto foi realizado para determinar quais deles mostram com precisão a condição clínica da psicopatia.

A lista contém 105 psicopatas masculinos e 21 femininos, todos retratados em filmes desde 1915.

Contudo, entre os filmes analisados, os retratos que realmente podem ser usados para ensinar e ilustrar esta patologia são a minoria.

Colocamos, de seguida, uma sugestão de filme no qual a representação da Psicopatia é, realmente, fidedigna.

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"No Country for Old Men" (em português, "Este País Não é para Velhos") é um filme estadunidense de 2007, escrito e dirigido pelos irmãos Coen, baseados no romance homónimo de Cormac McCarthy.

Segundo o que a equipa de psiquiatras escreveu no estudo, “a personagem Anton Chigurh é um psicopata bem concebido“.

“Faltam-nos informações sobre a sua infância, mas existem argumentos suficientes e informações detalhadas sobre o seu comportamento no filme para obter um diagnóstico de psicopatia ativa, primária e idiopática”, explicam.

A personagem apresenta “incapacidade de amar, ausência de vergonha ou remorso, falta de perceção psicológica, incapacidade de aprender com a experiência passada, atitude de sangue frio, crueldade, determinação total, e falta de empatia“, referem.

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Are Psychopaths Born or Created? Nature and Biology of Psychopathy

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Fontes da Informação Utilizada no E-Portfólio “Genética da Psicopatia”