Is psychopath in the dsm 5

Psychopathy, DSM-5, and a caution

. 2014 Oct;5(4):335-47.

doi: 10.1037/per0000078. Epub 2014 Jun 16.

Cristina Crego¹, Thomas A Widiger¹

Affiliations

Affiliation

¹ Department of Psychology, University of Kentucky.

PMID: 24932764
DOI: 10.1037/per0000078

Cristina Crego et al. Personal Disord. 2014 Oct.

. 2014 Oct;5(4):335-47.

doi: 10.1037/per0000078. Epub 2014 Jun 16.

Authors

Cristina Crego¹, Thomas A Widiger¹

Affiliation

¹ Department of Psychology, University of Kentucky.

PMID: 24932764
DOI: 10.1037/per0000078

Abstract

Recently developed models of psychopathy include such traits as fearlessness, boldness, and invulnerability. Section III of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes as well a psychopathy specifier that is modeled after these traits. The purpose of the current study was to test empirically the convergent and discriminant validity of the Psychopathic Personality Inventory-Revised (PPI-R), the Triarchic Psychopathy Measure (TriPM), the Elemental Psychopathy Assessment (EPA), and the Personality Inventory for DSM-5 (PID-5) with respect to their relationship to one another, with traditional measures of psychopathy and antisocial personality disorder, and with a measure of the 5-factor model. Participants were 2 samples of community adults (280 and 196) who indicated that they have engaged in criminal activities. The results indicated good convergent and discriminant validity for the PPI-R, TriPM, EPA, and the PID-5 psychopathy specifiers, as well as relationships with a measure of the 5 factor model that were quite distinct from the relationships obtained for traditional measures of antisocial personality disorder and psychopathy. However, concerns are raised with respect to a reliance on reverse-coded items for the assessment of components of psychopathy.

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Tracking Psychopathy in Female Italian Inmates: The Role of the DSM-5 Alternative Model of Personality Disorders Dysfunctional Personality Domains.
Somma A, Fossati A, Ferracuti S, Caretti V, Montalbò D, La Tegola D, Carabellese F. Somma A, et al. Clin Neuropsychiatry. 2019 Jun;16(3):140-148. Clin Neuropsychiatry. 2019. PMID: 34908949 Free PMC article.
Investigating the Validity Evidence of the Swedish TriPM in High Security Prisoners Using the PCL-R and NEO-FFI.

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Improving characterization of psychopathy within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), alternative model for personality disorders: Creation and validation of Personality Inventory for DSM-5 Triarchic scales.
Drislane LE, Sellbom M, Brislin SJ, Strickland CM, Christian E, Wygant DB, Krueger RF, Patrick CJ. Drislane LE, et al. Personal Disord. 2019 Nov;10(6):511-523. doi: 10.1037/per0000345. Epub 2019 Jul 1. Personal Disord. 2019. PMID: 31259604 Free PMC article.
The network of psychopathic personality traits: A network analysis of four self-report measures of psychopathy.
Tsang S, Salekin RT. Tsang S, et al. Personal Disord. 2019 May;10(3):246-256. doi: 10.1037/per0000319. Epub 2018 Dec 10. Personal Disord. 2019. PMID: 30525778 Free PMC article.

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MeSH terms

Characterizing psychopathy using DSM-5 personality traits

. 2013 Jun;20(3):327-38.

doi: 10.1177/1073191113486691. Epub 2013 Apr 24.

Casey M Strickland¹, Laura E Drislane, Megan Lucy, Robert F Krueger, Christopher J Patrick

Affiliations

Affiliation

¹ Florida State University, Tallahassee, FL 32306, USA.

PMID: 23620353
DOI: 10.1177/1073191113486691

Casey M Strickland et al. Assessment. 2013 Jun.

. 2013 Jun;20(3):327-38.

doi: 10.1177/1073191113486691. Epub 2013 Apr 24.

Authors

Casey M Strickland¹, Laura E Drislane, Megan Lucy, Robert F Krueger, Christopher J Patrick

Affiliation

¹ Florida State University, Tallahassee, FL 32306, USA.

PMID: 23620353
DOI: 10.1177/1073191113486691

Abstract

Despite its importance historically and contemporarily, psychopathy is not recognized in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised (DSM-IV-TR). Its closest counterpart, antisocial personality disorder, includes strong representation of behavioral deviance symptoms but weak representation of affective-interpersonal features considered central to psychopathy. The current study evaluated the extent to which psychopathy and its distinctive facets, indexed by the Triarchic Psychopathy Measure, can be assessed effectively using traits from the dimensional model of personality pathology developed for DSM-5, operationalized by the Personality Inventory for DSM-5 (PID-5). Results indicate that (a) facets of psychopathy entailing impulsive externalization and callous aggression are well-represented by traits from the PID-5 considered relevant to antisocial personality disorder, and (b) the boldness facet of psychopathy can be effectively captured using additional PID-5 traits. These findings provide evidence that the dimensional model of personality pathology embodied in the PID-5 provides effective trait-based coverage of psychopathy and its facets.

Keywords: DSM-5; PID-5; antisocial personality disorder; personality disorders; psychopathy.

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Somma A, Fossati A, Ferracuti S, Caretti V, Montalbò D, La Tegola D, Carabellese F. Somma A, et al. Clin Neuropsychiatry. 2019 Jun;16(3):140-148. Clin Neuropsychiatry. 2019. PMID: 34908949 Free PMC article.
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Prosocial behavior is associated with transdiagnostic markers of affective sensitivity in multiple domains.
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Publication types

MeSH terms

Grant support

MH072850/MH/NIMH NIH HHS/United States
MH089727/MH/NIMH NIH HHS/United States
MH65137/MH/NIMH NIH HHS/United States

Psychopathy and Diagnostic and Statistical Manual of Mental Disorders (DSM)

While virtually everyone understood the importance of the affective traits identified by Hare and Cleckley, some psychiatrists doubted the ability of the average medical practitioner to successfully recognize such signs as lack of empathy, guilt, and remorse.

There is one common mistake that leads to an overestimation of certain affective traits, such as lack of empathy, namely when the specialist focuses on one act, such as a serious crime, which caused the assessment of the person who committed it. For example, if a perpetrator has sexually abused a child, many interns will answer yes to the question of whether this behavior qualifies for a high score on the lack of empathy item. However, they may be wrong. Sex crime is just one piece of evidence suggesting a lack of empathy. For a high score, signs of this trait must be manifested in different areas of a person's life over a longer period of time - as Koch also showed in his epoch-making contribution to the study of personality traits (in disorder). So, a person who abuses a child may well deserve a high score on the Lack of Empathy scale, but if so, it is established because he showed a lack of empathy for a long time in all areas of life - and a single crime does not automatically guarantee a high score. .

In training clinicians, we teach them one technique in assessing psychopathy: to leave out the serious crime for which a person was taken into custody or tried. He should receive the same score, regardless of the crime that led to the prison term. In this way, you can avoid falling into the typical trap when, due to one terrible act, a specialist gives a person a high score on all counts.

Without proper training, the average practitioner is likely to be unable to diagnose psychopathy effectively. A simple solution to this problem is that the physician who has the professional need to evaluate psychopathy should receive special training. And this is one of the reasons why, in order to obtain a license for professional psychology and psychiatry, a doctor must improve his qualifications.

However, disagreement between those who believed that affective traits could be reliably diagnosed and their opponents has led many times to changes in the classification of psychopathy in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

DSM is the American bible of mental illness. The guide provides practitioners with a template for assessing and classifying patients. Diagnosing a patient is usually the first step towards optimal treatment. However, the definition of mental illness is a very confusing process, and I always teach students to go beyond the DSM. In other words, the DSM is a good starting point, but to really be on the cutting edge of psychiatry or up to date on the latest treatments, you need to know the pros and cons of any psychiatric diagnosis process. Moreover, the DSM is constantly changing and is based on science, economics and politics (and not necessarily in that order). Therefore, the researcher must definitely understand the history of the mental illness being studied and find out how it was defined in previous versions of the DSM.

The first DSM treatment options for antisocial personality disorder/psychopathy were widely dissatisfied{29}{30}. This prompted the American Psychiatric Association to conduct field studies in order to better describe the traditional symptoms of psychopathy in the manual. As a result, the DSM-IV (and DSM-V) reintroduced some of the affective criteria removed from the DSM-III, but so half-heartedly that it says practically nothing about how to compose a single whole out of individual symptoms.

Perhaps even more important - and more dangerous - is that forensic experts can diagnose a person with antisocial personality disorder as defined by the DSM, but misuse the literature as a List of Psychopathic Traits and misattribute the latest discoveries about recidivism and treatments to the person. who has only minimal dissocial symptoms.

I consult lawyers and judges on a regular basis, and I know that quite often they hear from their consultants that HRBA and DSM have the same criteria for antisocial disorder, when this is completely false.

In training workshops, I briefly describe the relationship between the DSM definition of antisocial personality disorder and the HRBA definition of psychopathy.

The DSM criteria for antisocial personality disorder are about halfway short of a diagnosis of psychopathy on Hare's list. If you are a general population physician and you interview a client and find that they meet DSM criteria, you can be sure that you are dealing with a very difficult person. But after that, you must go beyond the DSM and evaluate the signs of psychopathy using Hare's checklist. In this way, you will know if you are dealing with a psychopath, and this will allow you to develop a therapy program and a strategy for dealing with a client. If you work in the legal system, you should not even pay attention to the DSM criteria and use only the revised List of Psychopathic Traits.

The evolution of psychopathy research is full of unexpected twists, but the scientific community eventually managed to create a system for assessing this disorder. In the next chapter, I will take a closer look at the symptoms of psychopathy using the example of two famous killers.

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Sociopath: who is it, signs, differences from a psychopath

Charming scoundrels, tireless careerists, and sometimes predators in human form. We tell you who sociopaths are, how you can recognize them and how to communicate with them

Contents:

Sociopath, sociophobe and psychopath: the difference
How to recognize
Are sociopaths really smart and charming
How to treat
How to communicate
Can a sociopath fall in love
More to read

Who is a sociopath

A sociopath is a person with an antisocial (or antisocial) personality disorder. A sociopath ignores generally accepted norms of morality and behavior in society. For his own benefit, he lies and manipulates other people, giving the impression of being calculating, selfish and aggressive.

The word "sociopathy" comes from two words: the Latin socium - "society" and the ancient Greek pathos - "disease", that is, it denotes a violation in social relations, the inability to obey the rules of society [1].

The DSM-5 Mental Health Manual does not use the word sociopath. According to the handbook, a person with antisocial disorder might be called a sociopath or a psychopath, but these terms are not used to make a diagnosis. Doctors in Russia and abroad do not diagnose people with sociopathy, but with antisocial personality disorder [2].

History of the term

Doctors have noticed a long time ago cold selfish rationality in some patients, which often develops into aggressive behavior [3]. One of the first physicians to describe such people was the French physician Philippe Pinel, who in 1806 called their condition "madness without delirium" (maniaque sans délire), and his student, psychiatrist Jean-Etienne Dominique Esquirol (Jean Etienne Dominique Esquirol) - rational madness.

Another popular name, common in the USA and England in the 19th century, is moral insanity, that is, the inability to follow generally accepted moral standards. The term "psychopathy" was first used to describe such people in the late 19th century by the German psychiatrist Julius Ludwig August Koch.

In the 1930s, psychiatrists coined a new definition, sociopath, because the term "psychopathy" could easily be confused with psychosis, a bout of inappropriate behavior. In addition, the prefix "socio" reflected the widespread belief at the time that sociopaths were people whose behavior was influenced by the social environment, and not, for example, genetics.

The term “sociopath” was much more popular in the West than in Soviet and Russian psychiatry. In the West, many researchers have used sociopathy and psychopathy interchangeably. But in 1980, the third edition of the DSM handbook added the term "antisocial personality disorder" and it has been used as an official diagnosis ever since.

Culture has always had images of people with sociopathic traits. Cain is sometimes called the first sociopath, who, according to the Old Testament, killed his brother Abel. One of the most famous female sociopaths of ancient Greek mythology is Medea (on the left is Eugene Delacroix’s painting “Medea”, 1838), a princess and sorceress who killed her children to avenge her husband for treason. Another “literary” sociopath is King Shahriyar from “A Thousand and One Nights” (on the right is Anton Pieck’s painting “Scheherazade Tells Tales to Shahriyar”, 1943), who executed his wives after their wedding night. (Photo: mirovoeiskusstvo.ru, artnet.com)

At the end of the 20th century, the term “sociopath” was popularized by American culture: in many films and TV shows, the main characters go beyond social rules and norms. They do not always cause the approval of the viewer, but almost always - a burning interest.

Sociopathic villain, 15-year-old Alex deLarge in the film adaptation of Anthony Burgess's A Clockwork Orange, who commits crimes, ends up in jail, participates in an experiment to "cure" aggression, but in the end never becomes "normal" . A positive image of a sociopath is Sherlock from the BBC series. (Photo: www.fansshare.com, www.walesonline.co.uk)

According to neuroscientist James Fallon, who specializes in the study of psychopaths, Sherlock Holmes is a sociopath (or psychopath) who lacks empathy: he imitates emotions without actually experiencing them [4].

At the same time, Sherlock is very charismatic and in the series often demonstrates that he cares about other people's feelings. James Fallon, who is also a sociopath, explains that such empathy is not characteristic of them. This is probably an invention of the writers to make the main character more attractive to the audience. Real sociopaths are nasty people, Fallon points out.

Sociopath, sociophobe and psychopath: the difference

Sherlock's phrase in the British BBC series of the same name "I am not a psychopath, but a high-functioning sociopath" plays on the difference between a psychopath and a sociopath. But when making a medical diagnosis, there is no difference between sociopathy and psychopathy. The DSM-5 Handbook of Mental Disorders makes no distinction between the two—it defines both psychopaths and sociopaths as people with antisocial personality disorder.

However, some psychologists separate psychopaths and sociopaths from each other. Psychologist Robert D. Hare, who invented a special test for psychopathy (PCL-R), believes that sociopaths have a concept of morality, although it may differ from the generally accepted one [5]. Sociopaths have little empathy for others, but they understand the difference between good and evil. For psychopaths, there is no morality or empathy at all.

Some neurobiological studies indicate that sociopaths and psychopaths may have different brain structures [6]. Some areas of the brain in psychopaths are simply not developed. In sociopaths, these areas are normal and, despite antisocial behavior, they have the rudiments of morality. The behavior of sociopaths in comparison with psychopaths can also be explained by social reasons - for example, the influence of the environment, and not an abnormal structure of the brain.

Sociophobia and sociopathy are similar-sounding terms, but refer to completely different mental disorders. A sociophobe is a person who is uncomfortable being in society, he experiences anxiety when communicating with people. A sociophobe suffers not from antisocial, but from social anxiety disorder.

How to recognize a sociopath

Some doctors classify sociopaths into types. For example, the American psychologist and psychiatrist Eric Berne in his book "Introduction to Psychiatry and Psychoanalysis for the Uninitiated" divides them into two types:

Latent sociopath. According to Bern, he behaves normally in society, without causing problems to anyone. Such a person is not guided by moral considerations, but obey some kind of authority or doctrine (for example, an authoritarian religion or sect). An example of a latent sociopath is a lawyer without ethical principles. Confident in the guilt of his client, he, nevertheless, will try by all means to save him from prison. Such a sociopath operates within the framework of his own invented rules, not paying attention to public morality.
Active sociopath. He is also able to put on a mask of integrity if it suits him. But, unlike the first type, outside the reach of laws and justice, he does not restrain himself and does whatever he wants. Active sociopaths can be called some cold-blooded serial killers or, for example, successful scammers.

Not all scientists share this point of view [7]. Eric Berne also acknowledges that there are many kinds of sociopathic behavior, and one sociopath may be different from another. However, he notes common features common to people with this diagnosis:

Desire to get what you want at any cost. They say about such people that they go over their heads. They are not stopped by any remorse, nor intelligence prompts like "if I do this, it will fly into me." A sociopath always does what he wants, regardless of the consequences. Eric Berne notes the impulsive behavior of sociopaths: unlike a person who behaves badly because he challenges society or, for example, takes revenge on someone, a sociopath simply takes and does what he wants without hesitation.
Lack of empathy and compassion. The emotional palette of sociopaths is limited. They do not feel sympathy for others and are not able to experience deep sincere emotions of joy, happiness, admiration. Although, in order to achieve their goals, they can imitate them - for example, demonstrate feelings with words and facial expressions. Scientists agree that sociopaths are capable of experiencing negative emotions - anger, frustration and rage [8]. But it is possible that such seizures are different from those that ordinary people are susceptible to. A sociopath who wrote under the pseudonym M. Thomas the book Confessions of a Sociopath. Live without looking into the eyes, ”says that her anger cools instantly, giving way to cold calculation.
"Evil inclinations" manifested from childhood. Often sociopathic tendencies can be seen in childhood: expulsion from school for bad deeds, theft, constant getting into trouble. This creates the impression that this behavior cannot be influenced - the sociopath repeats it over and over again with other people and in a different environment.

These signs of antisocial disorder described by Berne and several others are listed in the DSM-5. There are eight criteria in total, and sometimes it is enough to make a diagnosis if the patient has three or four of these signs [9].

Some studies have revealed unusual differences between sociopaths and other people: for example, people with psychopathic traits prefer the bitter taste of food to everything else, they are not inclined to “infect” yawns from others and make little eye contact with the interlocutor [10], [11], [12 ].

There is evidence that sociopaths of all musical genres like rap the most [13]. Therefore, Hannibal Lecter, enjoying classical music, seems like another cinematic fiction. Mads Mikkelsen as Hannibal Lecter in Hannibal (Photo: Youtube)

Psychologist Sergei Pustovoitov warns against thoughtlessly labeling loved ones. If you decide to look for a sociopath in your environment, then most likely you will not find one, but you will find those who are familiar with sociopathic character traits - accentuations. This may be a lack of expressed sympathy, a tendency to lie and manipulation, as well as the predominance of personal interests over public ones. But none of these signs in itself is not decisive. The diagnosis of "sociopathy", or rather, "antisocial personality disorder", can only be made by a psychiatrist or psychotherapist.

Are sociopaths really smart and charming?

Sociopaths don't have to be intellectuals. Among them there are both people with high intelligence and low, explains clinical psychologist Alexei Mosin. The latter tend to be impulsive and prone to outbursts of aggression, unable to restrain themselves and therefore prone to criminal criminal behavior. Such sociopaths can often be found in prisons and other correctional institutions.

Sociopaths with high intelligence adapt much better in society. But this does not prevent them from neglecting the rights of other people, breaking boundaries or even laws. If they commit an unseemly act, this is usually a covert manipulation, intrigue, a "multi-move" combination, but not direct aggression.

Dr. House is another likely sociopath, teetering on the edge between inadequacy and genius. (Photo: www. tvn.cl)

According to Alexei Mosin, Dr. House from the popular series is a model of a person with a personality disorder: antisocial, but useful. His environment is ready to tolerate his behavior, as he is literally irreplaceable. Society gives House the so-called "idiosyncratic credit", that is, it forgives him for oddities, because his activities benefit others. Perhaps this attitude of society is one of the secrets of the charm of sociopaths.

Psychologist Sergey Pustovoitov explains that people with other mental disorders most often fall under the charm of sociopaths - for example, with a dependent disorder or the "victim" syndrome. For people with a healthy mind, a sociopath will be perceived as an unscrupulous, greedy voluptuary, and they will not buy his smile.

How sociopathy is diagnosed and treated

Psychologist Sergei Pustovoitov says that sociopaths do not seek psychiatric or psychotherapeutic help on their own. Their first encounter with a doctor occurs when, for example, they commit an offense and are required to undergo a medical examination. According to 2002 data, 47% of convicted men in 12 Western countries had antisocial personality disorder [14]. Sociopathy is also detected in offenders under the age of 18. Such juvenile sociopaths are the same "difficult children" from the children's room of the police. After the diagnosis is made, doctors and psychologists work with them, treatment is prescribed - these can be medications and psychotherapy.

Clinical psychologist Alexei Mosin confirms that people with antisocial disorder rarely go to the doctor themselves. One of the signs of sociopathy is the denial of such a disorder, and sociopaths will not voluntarily come into therapy.

Antisocial disorder is most often diagnosed in people from low-income or large families, says Yulia Levchenko, psychiatrist and psychotherapist at the Federal Research and Clinical Center of the Federal Medical and Biological Agency of Russia. At the same time, concomitant diseases or injuries are often detected in them - physical or moral violence in a close environment, craniocerebral disorders and neuralgia, mental retardation or schizophrenia, alcoholism and drug addiction. In all these and other cases, the diagnosis of "antisocial personality disorder" can only be made by a qualified specialist - a psychotherapist or psychiatrist. He will focus, among other things, on the signs indicated in the DSM-5 mental disorders directory.

Despite the fact that it is difficult for sociopaths to adapt in society, they are rarely recognized as incompetent and receive a disability, notes Yulia Levchenko. Patients with schizophrenia, severe psychosis, and clinical depression are much more likely to receive disability.

Neuropsychologist Alexei Leontiev explains that in Russia a sociopath with a confirmed diagnosis does not receive any benefits or concessions. Such people are restricted in their rights to carry weapons and obtain a driver's license. They will not be hired to work in government agencies - they use special tests (SMIL) to identify possible mental disorders [15]. And when committing a crime, a sociopath will face more severe punishment than if he was undiagnosed. The court proceeds from the fact that a sociopath, having broken the law once, is likely to break it the next time.

How to communicate with a sociopath

Gelana Shirikinova, a medical psychologist at the Medscan clinic, advises when communicating with a sociopath:

speak harshly and firmly, the arguments in the conversation should be categorical and not subject to objection;
keep your composure: no need to cry, fight and fall into hysterics, as this "feeds" the sociopath, making him stronger;
do not succumb to provocative behavior: blackmail, suicide threats and other manipulations;
do not give the sociopath any indulgence: if a prohibition is established for a sociopath, then in case of violation, punishment must necessarily follow.

If it is possible not to communicate with a sociopath at all, it is better not to communicate, says neuropsychologist Alexei Leontiev. If it turns out that a loved one is a sociopath, then you should distance yourself from him as much as possible. A sociopath will in any case do what he wants, in any situation he will manipulate others - in a soft or overwhelming manner. People around a sociopath, in an attempt to change his personality, run the risk of encountering aggression or even violence, and, by submitting to a sociopath, derail their lives.

Aleksey Mosin shares a similar opinion. Relatives of a sociopath live in constant anxiety and fear, because one of the consequences of sociopathy is great difficulty in adapting to society, not only for the person with the diagnosis, but also for the people around him. Simply put, it is extremely difficult for people around a sociopath to lead a normal life. They often need professional help. This is where mindfulness, interpersonal effectiveness, emotion regulation, and stress management training can help. They are recommended by psychologists as part of dialectical-behavioral psychotherapy, a special method of treating "difficult" patients with mental disorders. Such trainings will also be useful for those close to a sociopath, Alexey Mosin believes.

A sociopath does not experience empathy to the extent that other people do. And therefore, emphasizes Alexei Leontiev, one can become an authority for him only with the help of physical or mental suppression. In his opinion, the only way to cope with a sociopath is to be a psychopath, a cold-blooded manipulator of the overwhelming type.

Can a sociopath fall in love? Scientists suggest that the ability of a sociopath to love depends on how developed his antisocial disorder is [16]. People who score high on the Hare Psychopathy Scale (PCL-R) are more likely to avoid any attachment. If they enter into a relationship, it is not because they fell in love, but because the relationship brings some benefit to them.

A sociopath's relationship with another may not be based on attachment and psychological intimacy, but, for example, on a shared view of the world. A good example is the union of Bonnie and Clyde, in which both are trying to get as much as possible from other people. Perhaps now one of them, or both of them, would be diagnosed with antisocial disorder. Pictured is a frame from the movie "Bonnie and Clyde", 1967 (Photo: www.sheknows.com)

Researchers have studied the impact of a sociopath on his partner and on their relationship in general [17]. They tested 140 couples aged 18 to 35 on a psychopathy scale. In addition, each of the partners was separately asked about the strength of his attachment: how high is their fear of being abandoned and the desire to avoid emotional contact. The researchers followed the couples for a year and re-surveyed a year later. It turned out that men with pronounced sociopathic traits showed an inability to get close to their partner. In addition, a woman paired with a sociopath over time became more detached, disappointed in the relationship. And men in relationships with a sociopathic woman became emotionally unstable, anxious and dependent.

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