A psychopath is a psychopath is a psychopath. Right?

Not necessarily. Psychopaths may be influenced by cultural factors, according to a study of 7450 criminal offenders exhibiting psychopathic characteristics in the Netherlands and United States. The study suggests that despite sharing certain central traits, psychopaths can vary based on their culture. The research team, led by Bruno Verschuere, associate professor of forensic psychology at the University of Amsterdam, the Netherlands, used the Psychopathy Checklist (PCL-R) to evaluate the criminal and rehabilitative tendencies of psychopathic individuals. The checklist comprises 20 factors that denote personality traits and behaviors typical of psychopathy, such as callousness, selfishness, and antisocial behavior. The team found callousness to be the primary behavior in the US-based offenders. Meanwhile, the predominant behaviors in the Dutch offenders were irresponsibility and parasitic lifestyle.1

The study raises several questions: Are psychopaths merely products of social, environmental, or cultural circumstances? Are they “normal” people lost in a web of misunderstandings, or regular offenders judged on cultural perceptions?

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What Is Psychopathy?

Interestingly, the term “psychopath” is shrouded in ambiguity. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Revision (DSM 5), “psychopath” is not a diagnosis. Rather, the entry is of antisocial personality disorder (ASPD). Although many consider ASPD to be synonymous with psychopathy, the disorders are very different.2 According to David Kosson, PhD, from the Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, “The term psychopath is widely misused. People make distinctions between psychopaths and sociopaths, but there is no basis for that distinction.” Furthermore, he clarifies that whereas ASPD is a personality disorder characterized by frequent involvement in criminal behavior and other antisocial activities, it is not the same as psychopathy. ASPD was the chosen term for psychopathy to include in the taxonomy written by the American Psychiatry Association in 1980. The diagnostic criteria in the DSM 5 emphasize the impulsive, irresponsible lifestyle features of psychopathy, but they do not effectively capture the core components of psychopathy.

Today, 4 distinct components of psychopathy are considered; of these, the affective and interpersonal are considered the core features. The other 2 components (lifestyle and antisocial features) are also important, but are less specific to psychopathy. Thus, about half of all people with ASPD score high on the interpersonal and the affective components. They may be impulsive, irresponsible, and get into trouble, but only 50% will demonstrate classic psychopathic traits.

“ASPD is a personality disorder characterized by impairments in personality functioning and by the presence of pathological personality traits,” said Claudio Vieira, MSc, specialist clinical psychologist under the London Pathways Partnership, Offenders Personality Disorder Strategy. “However, while offenders with psychopathy usually have ASPD, ASPD offenders are not necessarily psychopaths.”

But what makes a person psychopathic in the first place, and is the cause cultural?

The Seeds of Psychopathy

According to Vieira, the biopsychosocial model suggests that personality disorders develop as a result of interaction among biological vulnerabilities (genetic elements that influence personality), critical early experiences (relationships that determine the person’s formative views of the world), and social factors (living conditions, employment, financial status, social standing, and relationship dynamics).

Dr Kosson noted similar points, explaining that people commit different criminal acts for different reasons: Genetics contribute significantly, and some evidence also suggests the influence of environmental factors. For example, disruptions in relationships early in life may facilitate the development of psychopathic traits. Referring to a research paper he published in 2017, Dr Kosson asserts that early environmental factors appear to be associated with the development of psychopathic behavior.3 The research entailed in-depth interviews with the parents of adolescents about life-changing events in the first 4 years of their child’s life. It appeared that these events were related to the affective features of psychopathy.

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Dr Kosson also cited studies that have explored psychopathy and ethnicity. Offenders with major psychopathic traits can be identified in all ethnic groups that have been studied, including European Americans, African Americans, and Latino Americans, but some of the evidence pointing to the validity of psychopathy is stronger in European Americans.4

Research on other ethnic and cultural groups reinforces the existence of cultural differences between psychopathic individuals. For instance, Svetlana Oshukova, MD, PhD, from Helsinki University and Helsinki University Hospital, Finland and colleagues found that the manifestation of psychopathic traits in adolescents appears to be significantly influenced by culture. The study of 372 Finnish and 474 Dutch adolescent students revealed culture-related differences in juvenile psychopathic traits, with boys scoring higher than girls in both geographies. Further, the Dutch boys scored higher on psychopathy levels than the Finnish boys.5

Culture or Coincidence?

Dr Kosson believes there is currently no strong evidence regarding cultural differences in psychopathology. In general, common psychopathic traits can be identified in people cross-culturally, with most of the correlates of psychopathy appearing to be relatively similar across different cultures. For instance, psychopathy is universally associated with other personality disorders, substance abuse and dependence, and criminal behavior. In terms of experimental findings, psychopathic traits have not been studied as widely outside of North America.

In 2015, Dr Robert Latzman and his team conducted a cross-national comparison of psychopathy across Saudi Arabia, Egypt, and the United States. They found that behaviors were similar across different cultures, but also that there are possible cross-cultural differences in traits such as “cold-heartedness” in the Middle East.6

Nevertheless, there are not yet enough proven variations to propagate the conclusive existence of cultural differences in psychopathology.

The Enigma Evolves

In addition to the challenges posed by gray definitions of psychopathy, associated research is influenced by the measurement variance of the PCL-R. Dr Kosson explains that the criminal justice system tends to demonstrate a more severe disposition for ethnic minority individuals than for European Americans. This might contribute to measures not working as consistently or universally as expected.

Ultimately, much about psychopathy remains unknown or inconclusive. As Dr Kosson aptly stated, “We are learning a great deal, and so much great research is being done that what we know keeps changing. Discrepancies in universal psychopathic behavior between cultures do appear to exist. However, it is premature to conclude that psychopathic individuals differ systematically across cultures.”

Indeed, we are learning something new each day. In March 2018, a Yale University study challenged the popular belief that psychopathic individuals lack social awareness. The study suggested that “psychopathic individuals have a diminished propensity to automatically think from another’s perspective.” With enough understanding, they can pick up on social cues as effectively as others.7

As we traverse the world of psychopathic research, it will be fascinating to witness the new discoveries unearthed along the way.


  1. Verschuere B, van Ghesel Grothe S, Waldorp L, et al. What features of psychopathy might be central? A network analysis of the Psychopathy Checklist-Revised (PCL-R) in three large samples. J Abnorm Psychol. 2018;127(1):51-65.
  2. Kramer S. 5 things everyone gets wrong about psychopaths — and why you might be one. Business Insider. https://www.businessinsider.com.au/pop-culture-misconceptions-about-psychopaths-sociopaths-2016-8#/#1-its-not-very-clear-what-a-psychopath-is-1. Updated January 31, 2018. Accessed April 19, 2018.
  3. Sevecke K, Franke S, Kosson D, Krischer M. Emotional dysregulation and trauma predicting psychopathy dimensions in female and male juvenile offenders [published online November 1, 2016]. Child Adolesc Psychiatry Ment Health. doi: 10.1186/s13034-016-0130-7
  4. Vitacco MJ, Kosson DS. Understanding psychopathy through an evaluation of interpersonal behavior: testing the factor structure of the interpersonal measure of psychopathy in a large sample of jail detainees. Psychol Assess. 2010;22(3):638-649.
  5. Oshukova S, Haltiala-Heino R, Hillege S, et al. Short report: self-reported psychopathic traits in Finnish and Dutch samples of non-referred adolescents: exploration of cultural differences. J Abnorm Psychol. 2016;10:3.
  6. Latzman RD, Megraya AM, Hecht LK, Miller JD, Winiarski DA, Lilienfeld SO. Self-reported psychopathy in the Middle East: a cross-national comparison across Egypt, Saudi Arabia, and the United States [published online October 29, 2015]BMC Psychology. doi: 10.1186/s40359-015-0095-y
  7. Drayton LA, Santos RL, Baskin-Sommers A. Psychopaths fail to automatically take the perspective of others [published online March 12, 2018]. PNAS. doi: 10.1073/pnas.1721903115

This article originally appeared on Psychiatry Advisor