Psychopathy

figure1-1You will notice that psychopathy is not present among the personality disorder disorders, although it is entirely true to say that psychopathy – as described by Robert Hare’s Psychopathy Checklist-revised (PCL-R) – is a type of personality disorder. In fact, psychopathy could be thought of as a sub-set of antisocial PD, a particularly severe form of the disorder, often with additional narcissistic, paranoid, sadistic and/or borderline traits (see Figure 1.1, illustrating the relationship between offenders and personality disorder). This is a particularly important personality type in offender services as it is linked to very high levels of re-offending, violence, and failure to comply with statutory supervision.

To complicate matters further, psychopathic disorder was a legal category (now no longer in use) of the 1983 Mental Health Act which can be applied to all personality disorders. It does not necessarily indicate someone with a high PCL-R score; it does indicate that an individual was placed in hospital on the basis that their primary diagnosis was thought to be personality disorder rather than mental illness. The requirement of the Act is to provide interventions which address some combination of the personality characteristics, associated behaviour and the offences. There continue to be individuals detained in secure hospitals under this category, many of whom will eventually be managed in the community. References to psychopathic disorder may be noticed in reports and case records written before October 2008.