[From conduct disorder in childhood to psychopathy in adult life]

Abstract

Mental health professionals seldom recognize psychopathy in their daily practice. Usually forensic psychiatrists and psychologists are involved because individuals with psychopathic personality are involved in serious criminal behavior and implicated with the law. Most of the times the profiles of children who evolve in adult psychopaths have components from other disorders, especially conduct disorder. The term psychopathy originates from the Greek words "psyche" (soul) and "pathos" (passion) and was used to identify initially every mental illness. Although in the bibliography the terms Antisocial Personality Disorder, Psychopathic Personality, Psychopathy and Sociopathy are used as synonyms, it has not been clarified if the Antisocial Personality Disorder and Psychopathic Personality constitute two different entities or if the latter constitutes the more serious and hard core subtype of the first. The prevalence of Psychopathic Personality in the general population is estimated as 1%, with the proportion of men: women to be 3:1. The adult male psychopaths are responsible for almost 50% of the serious criminal behavior. Diagnosis of Psychopathic Personality is completed with the use of specific psychometric tools: Psychopathy Checklist-Revised (PCL-R) and Psychopathy Checklist: Screening Version (PCL: SV). The most recognizable elements of psychopathy are the non-existence of conscience and their shallow emotional relations. They are individuals with persuasion, that use the suitable phraseology in order to approach, impress and charm their prey. Nuclear characteristic is the inability to feel guilt, remorse and the nonexistence of moral rules. They lose their temper easily and present aggressiveness without obvious or insignificant reason. They develop various antisocial behaviors that are repeated with success, the gravity of violent behavior tends to increase and they have problems with the law. Nevertheless, people with Psychopathic Personality at one point were children, without diagnosis of Psychopathic Personality, as such a diagnosis is not appropriate at early childhood or adolescence. Psychopathic or/and antisocial tendencies sometimes are recognized in children and early adolescent age. Such behaviors lead usually to the diagnosis of Conduct Disorder or Oppositional Defiant Disorder or Attention Deficit and Hyperactivity Disorder in early years of life and increase the possibility to have a diagnosis of Antisocial Personality Disorder and Psychopathic Personality as an adult. There are many studies on the underlying risk factors for Psychopathic Personality, focusing in genetic, neurobiological, developmental, environmental, social and other factors. There is no effective treatment for Psychopathic Personality in adult life. Children with a specific neurobiological profile or behavioral disturbances that increase the risk of developing a Psychopathic Personality in adult life, have better chances to respond in exceptionally individualized interventions, depending on the character of the child. The parents are educated to supervise their children, to overlook annoying behaviors and to encourage the positive ones. It appears that the punishment does not attribute, on the contrary it strengthens undesirable behaviors. Use of reward appears to have better results. Programs of early highly focused therapeutic interventions in vulnerable members of the population are our best hope for the reduction of fully blown psychopaths in the general adult population.