449006

International Journal of Offender Therapy and Comparative Criminology

IJO56410.1177/0306624X12449006Palermo

Editorial

Psychopaths and
Posttraumatic Stress

International Journal of
Offender Therapy and
Comparative Criminology
56(4) 503504
The Author(s) 2012
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DOI: 10.1177/0306624X12449006
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George B. Palermo

Psychopaths and psychopathic behaviors have no doubt existed since the beginning of
civilization, but the construct of psychopathy dates to the time of Pinel and Lombroso,
who were followed by a long line of criminological scholars up to the present
(Palermo, in press). Cleckley (1955), in his seminal work, The Mask of Sanity,
described the psychopath as grandiose, arrogant, callous, superficial, manipulative,
cold, distant, and free of apparent anxiety about the distress he causes his victims and
showing no empathy for them. Hare (2003) introduced the Psychopathy Checklist
(PCL), a two-factor model, for use in research and in forensic setting assessments of
these persons, and in a later revised form, the PCL-R, he proposed a four-factor model.
Basically it is a 20-item symptom construct grouped together into two or four clusters.
The PCL-R scales offer a reliable assessment of psychopathy in the tested individual.
Briefly stated, the PCL-R shows each factor composed of two facets: Factor 1 is composed of one interpersonal and affective facet and Factor 2 by lifestyle and antisocial
facets.
Prior to Hares PCL-R scale, Gray, 1970 (cited in Fowles & Dindo, 2006) had proposed a theory of an anxiety deficit in psychopathy, stating that an anxiety response to
traumatic situation is under the activity of the Behavioral Inhibition System (BIS) and
its counterpart the Behavioral Activation System (BAS). These two systems, together
with the amygdala, usually balance anxiety reactions.
Later, Gray and McNaughton (2000) pointed out that fear and anxiety are negatively associated with PCL-R Factor 1 (interpersonal and affective facets), whereas
Factor 2 (lifestyle and antisocial facets) dimensions lead to disinhibited aggressive
behavior. Simply put, according to this thinking, a traumatic stress situation addresses
Factors 1 and 2 in different ways, and a high Factor 1 tends to minimize a traumaticanxiety effect on the individual. Therefore, there will be no posttraumatic stress (PTS).
Vice-versa trauma impinging on Factor 2 is conducive to PTS.
In this issue of the International Journal of Offender Therapy and Comparative
Criminology, Jochem Willemsen, Julie De Ganck, and Paul Verhaeghe, in a well-written
and well-researched article, ask the question of whether a psychopathcallous, distant,
Corresponding Author:
George B. Palermo, M.D., M.Sc., Ph.D. 2169 Silent Echoes Drive Henderson, NV 89044 USA
Email: palermogb@juno.com

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International Journal of Offender Therapy and Comparative Criminology 56(4)

and apparently indifferent to the pains of his victimsis free from anxiety or PTS due to
the traumatic situation that he himself caused. They examined two theoretical models of
the interaction between psychopathy, traumatic exposure, and lifetime PTS in a sample
of 81 male detainees. They found that the interpersonal/affective facets of Factor 1 are
negatively associated with anxiety and PTS. In other words, a high Factor 1 protects the
psychopath from PTS. However, they were unable to confirm the positive association of
Factor 2, the frequency and versatility of traumatic experiences, and PTS as previously
posited. This is an interesting finding that obviously needs further investigative research.
Clinical experience indicates that the psychopath certainly appears to be free from
postcrime anxiety or lifetime PTS. And it is a common assumption that as time goes
by, the psychopath becomes even more callous, ruthless, and unconcerned about his
crimes and their frequency, and shows no anxiety related to them. However, before
drawing conclusions in such investigations, the possibility of the presence of dissociative subtypes of psychopathy should be taken into consideration. Recent research
shows that brain imaging findings of those psychopaths show excessive prefrontal
cortical activity and the suppression of anxiety-producing amygdala activity. The psychopaths themselves show no evidence of anxiety or PTS (Moran, 2012).
The article by Willemsen and colleagues is very thought provoking and together
with the other articles in this issue will certainly stimulate our criminological
thinking.
George B. Palermo, M.D., M.Sc.Crim., Ph.D.
Editor-in-Chief
Clinical Professor of Psychiatry, University of Nevada
School of Medicine, Reno, NV, USA
Medical College of Wisconsin, Milwaukee, WI, USA
Adjunct Professor of Criminology, Marquette University, Milwaukee, WI, USA
References
Cleckley, H. (1955). The mask of sanity: An attempt to clarify some issues about the so-called
psychopathic personality. St. Louis, MO: C. V. Mosby.
Fowles, D. C., & Dindo, L. (2006). A dual-deficit model of psychopathy. In C. J. Patrick (Ed.),
Handbook of psychopathy (pp. 14-34). New York, NY: Guilford Press.
Gray, J. A. (1970). The psychophysiological basis of introversion-extraversion. Behaviour
Research and Therapy, 8, 249-166.
Gray, J. A., & McNaughton, N. (2000). The neuropsychology of anxiety: An enquiry into the
functions of the septohippocampal system (2nd ed.). Oxford, UK: Oxford University Press.
Hare, R. D. (2003). The Hare Psychopathy ChecklistRevised (2nd ed.). Toronto, CA: MultiHealth Systems.
Moran, M. (2012, April 6). Recent data lead to shift in PTSD criteria. Psychiatric News, p. 33.
Palermo, G. B. (In press). In J. B. Helfgott (Ed.), Criminal psychology (Vols. 1-4). Westport,
CT: Praeger.

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