Criminal Minds- Extreme Aggressor

The episode itself had a weak plot and wasn't all too great, but a lot of thought-provoking material made the show worthwhile. The “unsub” (unknown subject) was labeled psychopathic and suffered from paranoid psychosis. The diagnosis struck me as peculiar because according to the DSM-IV-TR, American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders Text Revision, the psychopathic conditions are more commonly referred to as antisocial personality disorder. Psychopathy was first systematically described by psychiatrist Hervey M. Cleckley in 1941. Psychopaths can be manipulative, superficial, and appear remarkably normal. However, they are without remorse, egoistic, dishonest, irresponsible and impulsive. Shows like Criminal Minds love this definition because it is the perfect basis on which to create a violent killer.

The Psychopathy Checklist-Revised (PCL-R) was developed by psychologist Robert D. Hare and measures psychopathy in three areas: interpersonal deficits (such as grandiosity, arrogance and deceitfulness), affective deficits (lack of guilt and empathy), and impulsive and criminal behaviors (including sexual promiscuity and stealing).

Interestingly enough, antisocial personality disorder is comprised of many, if not all if the traits of psychopathy. There seems to be a fine line between what is considered psychopathy and what is antisocial personality disorder. Mentalhealth.com states,

“About 80-85% of incarcerated criminals have Antisocial Personality Disorder. However, only about 20% of these criminals would qualify for a diagnosis of being a psychopath. Most psychopaths meet the criteria for Antisocial Personality Disorder, but most individuals with Antisocial Personality Disorder are not psychopaths. Psychopaths account for 50 percent of all the most serious crimes committed, including half of all serial killers and repeat rapists.”

The source seems credible, but because the words are so interchangeable, more research is definitely needed to support this conclusion.

Psychopathy is not psychosis. Nor are psychopaths psychotic. Psychosis is most commonly seen in schizophrenic patients who lose touch with reality and become irrational. Psychopaths are known to be logical and are well aware that their actions are wrong and unacceptable in society, but because they do not feel guilt there is no harm in completing these actions.

Treatment is said to be effective is psychopathy. Psychologist Jennifer Skeem of the University of California Irvine, and her colleagues suggests that psychopaths may benefit as much as nonpsychopaths from psychological treatment. However, considering that antisocial personality disorder and psychopathy are so similar, treatment may not be that easy. Personality disorders have been known to be hardest to treat and have a significantly lower treatment rate than that of other psychological disorders. This is because personality is so complex and an intricate part of identity that it becomes intangible.

If anyone has any feedback regarding this issue, I would be interested to hear what the difference is between these two diagnoses.