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Personality / Styles

Psychopathic Personality Style

The psychopathic style is organized around power. Its central question is not “Am I loved?” or “Am I good?” but “Do I have an effect? Am I winning? Am I weak?” Nancy McWilliams, following Bursten, describes the organizing preoccupation as “getting over on” other people, and stresses that the diagnosis has to do with inner motivation rather than with breaking the law (McWilliams, 2011, p. 158). The Psychodynamic Diagnostic Manual (PDM-3) likewise prefers the older word “psychopathic” to “antisocial,” because many people with this personality are not visibly at odds with society at all. Some pursue their aims with social approval, and some occupations reward the style (McWilliams & Shedler, 2026, p. 692).

The ingredients of this style are not all destructive. People with psychopathic traits feel anxiety less often and less intensely than others, which can make them cool under pressure and hard to intimidate. Many are charming, and the PDM-3 notes that some can read other people’s emotional states with striking accuracy (p. 693). Lykken suggested that heroes and people with psychopathic traits may share a fearless temperament, and that warm, effective socialization helps decide which way that temperament goes (Costello et al., 2018). McWilliams points out that healthy remnants of childhood omnipotence, the sense that our will can make things happen, are part of everyone’s feeling of competence (2011, p. 107).

It is also honest to say that this style, along with the sadistic one, is the hardest to find at healthy levels, and that when it is central to someone’s personality, other people often get hurt. The clinical literature describes it mostly in its more severe forms. Yet the same writers insist that people organized this way are human beings who can sometimes be helped, and that understanding them is not the same as excusing harm (McWilliams, 2011, pp. 171–172).

Everyone has a personality style, and most of us have some ruthless, power-hungry impulses. McWilliams argues that clinicians who work with this group have to find those parts in themselves (2004, p. 148). What follows describes a pattern, not a verdict on any person.

Style, Disorder, and the Space Between

The PDM-3 treats personality styles as matters of degree. A clinician rates how closely a person matches a description rather than deciding that they have or lack a category (McWilliams & Shedler, 2026, p. 666). The authors are candid, though, that psychopathic styles are found mainly at the borderline and psychotic levels of organization, because the pattern depends on primitive defenses (pp. 655, 665, 692). McWilliams agrees that the continuum “loads heavily” toward the more disturbed end, because the concept refers at bottom to a failure of attachment (2011, p. 158).

At the healthy end, a fully psychopathic personality is rare. What shows up more often is a psychopathic streak in someone whose main style is something else: a taste for risk and competition, comfort with power, and an ability to stay calm when others panic, together with a working conscience and real attachments. Lykken’s picture of a fearless child who is warmly and effectively raised fits here (Costello et al., 2018).

At the neurotic level, McWilliams, following Bursten, describes high-level antisocial personalities. These people have enough identity integration, reality testing, and mature defenses to be neither borderline nor psychotic, but their core outlook is still antisocial. Given enough ego strength, ruthless indifference to others can make competitive success easier (2011, p. 158). The PDM-3’s adolescent chapter describes young people at this level who hide their coercive intentions, use their intelligence to outmaneuver others, and form transactional relationships while doing well at school and work (Tanzilli & Sharp, 2026, p. 500).

At the borderline level, where most of the clinical literature sits, identity is diffuse, primitive defenses dominate, relationships are exploitive or unstable, and behavior may be either impulsive or coldly planned.

At the psychotic level, reality testing itself is compromised. The PDM-3’s adolescent chapter describes lower-functioning young people with these features as showing thinking problems, poor reality testing, and a greater likelihood of dangerous behavior (p. 500). McWilliams notes that the range runs from disorganized, psychotic people to “urbane, polished charmers” (2011, p. 158).

Signs that a psychopathic style has become a disorder include:

Bad behavior alone does not make the diagnosis. Some young people who break rules are deeply attached to peers in a criminal subculture, and others are reenacting a specific trauma (Tanzilli & Sharp, 2026, p. 500).

Official systems handle this territory differently. DSM-5 and DSM-5-TR keep a categorical antisocial personality disorder, defined mainly by behavior: a pattern since age 15 of disregarding and violating others’ rights, deceit, manipulation, and impulsivity, with evidence of conduct disorder before age 15 (Helle et al., 2019). The PDM-3 criticizes this definition for underemphasizing core personality traits (Tanzilli & Sharp, 2026, p. 498). ICD-11 has dropped named personality types. Instead it rates severity and lets clinicians note a trait called Dissociality, defined as disregard for the rights and feelings of others, including self-centeredness and lack of empathy (Bach & First, 2018). “Psychopathy” as such is not an official diagnosis in either system (Abdalla-Filho & Völlm, 2020). McWilliams warns that behavioral criteria tend to overdiagnose people who are poor or marginal and underdiagnose people who succeed in mainstream roles (1999, pp. 88–89; 2011, p. 168).

Inner World

The central tension is between omnipotence and helplessness. McWilliams describes self-images polarized between a wished-for state of personal omnipotence and a feared state of desperate weakness (2011, p. 165). One theory is that children who never felt reliably powerful, or reliably protected, at the right developmental moments may spend their lives seeking confirmation of their power (p. 163).

Feelings are hard to name in this style. McWilliams describes a general state of arousal rather than distinct emotions, the pattern Modell called a “massive affect block.” When feeling does break through, it tends to come as blind rage or manic exhilaration (pp. 159–160). Ordinary emotions are associated with weakness, and words are experienced as tools for controlling others rather than for expressing an inner state (p. 163). Hervey Cleckley, whose 1941 book gave the pattern its classic clinical portrait, thought people with this condition could learn the words and the outward “pantomime of feeling” without the feeling itself (Cleckley, 1988, p. 374).

Research on temperament adds part of the picture. Studies find lower and less frequent anxiety and an unusual craving for stimulation (McWilliams & Shedler, 2026, p. 693). McWilliams cites findings of low autonomic reactivity, which may help explain sensation seeking and what Cleckley called a “failure to learn by experience.” She also cites a gene–environment interaction in which people with a particular genetic variant were much more likely to develop violent and antisocial patterns if they had been maltreated as children (2011, p. 159). An old debate asked whether people with this style lack anxiety or simply discharge it in action too fast for anyone to see. McWilliams concludes that the research favors low anxiety, at least in the most extreme cases, but notes that people with antisocial tendencies who are healthy enough to take part in therapy may feel some anxiety, which can help motivate change (p. 162). The PDM-3 notes evidence for genetic contributions, while also tying psychopathic traits to severe childhood abuse (p. 692). It adds that unconscious shame may help drive psychopathic behavior (p. 693).

Pathogenic beliefs are the unconscious convictions about self and others that shape behavior. Read from the clinical descriptions above, they might include:

Self-esteem is maintained by winning, outsmarting, and making one’s effect felt, and the PDM-3 notes that “winning” can matter more than whatever is won (p. 692). Self-esteem is threatened by limits, exposure, and humiliation. McWilliams observes that anyone whose favorite self-image is unrealistically superior, and who runs into evidence of being only human, may try to restore self-esteem by exerting power (2011, p. 165). She also highlights envy, and the devaluing of tenderness that envy can produce: “one probably cannot grow up unable to love without knowing that there is something out there that other people enjoy that one lacks” (p. 165).

In terms of the PDM-3 mental capacities, the style tends to show up as difficulties in the capacity for trust, empathy, and intimacy, in internal standards and ideals, and in affect regulation. In the more impulsive versions, impulse regulation is affected too.

Defenses

McWilliams names omnipotent control as the primary defense. This is a need to feel and demonstrate one’s power that takes precedence over all other aims, related to the defense the site calls omnipotence. In her account, the drive to exert power also defends against shame (2011, p. 160). If a personality is organized around enjoying the sense of having exercised power, with practical and ethical concerns secondary, she places it in the psychopathic range (p. 108). She adds three more characteristic defenses (pp. 160–162):

The PDM-3 adds projection, devaluation, and denial (p. 692), and its adolescent chapter adds splitting (p. 499). Cleckley noted that even excellent logic tends to serve rationalization rather than judgment (1988, p. 374).

Two clarifications matter. First, McWilliams reserves the word “manipulation” for deliberate, ego-syntonic use of other people, meaning use that feels acceptable to the person. She distinguishes it from the indirect ways people with hysterical or borderline dynamics may try to get their needs met. Those can leave others feeling used, but they are unconsciously aimed at keeping relationships rather than exploiting them (2011, pp. 160–161). Second, not everyone with this style is impulsive. McWilliams cites evidence that a significant subgroup is planful and predatory, driven by a cold, chronic anger rather than a sudden loss of control (1999, p. 114; 2004, p. 279).

Relationships

In relationships, other people tend to matter for their usefulness. McWilliams writes that in deeply antisocial psychology, the value of others reduces to their usefulness in demonstrating clout (2011, p. 160). The PDM-3 adds that interest fades once people stop being useful, and its prototype describes a familiar cycle: promises that “this time is really different,” followed by a return to old behavior (p. 693). Partners, colleagues, and therapists often describe being charmed first and disturbed later.

The developmental theories are theories, and they describe risks, not destinies. Clinicians since August Aichhorn have described childhoods marked by a confusing mix of harsh discipline, overindulgence, and neglect, along with instability, losses, and addiction in the family (McWilliams, 2011, pp. 162–163). A recurring observation is that these children were indulged materially but deprived emotionally (p. 163). Psychoanalytic writers such as Otto Kernberg and J. R. Meloy emphasize a failure of attachment and of taking in good relationships, and research links psychopathic traits to severe abuse and disorganized attachment (McWilliams, 2011, p. 163; McWilliams & Shedler, 2026, p. 692).

Two other routes appear in the literature:

Donald Winnicott offered a hopeful lens on younger people. As de Felice and Tutal (2023) summarize his papers, he linked the “antisocial tendency” to a real deprivation, the loss of something good that had once been there, and read antisocial acts as carrying a hope that the environment would finally respond.

Many people with this style “burn out” in middle age. As physical power declines and limits become unavoidable, omnipotent defenses lose their grip, and some become more open to help (McWilliams, 2011, p. 161).

In Therapy

Two terms help here. Transference is the set of expectations and feelings a person brings from earlier relationships into the therapy relationship. Countertransference is the therapist’s emotional response, which can be a useful source of information.

In this style, the basic transference is an assumption that the therapist, like everyone else, has a selfish angle. If the therapist can be useful, for example by writing a good report for a court, the person may be strikingly charming (McWilliams, 2011, p. 166). McWilliams notes that people with this style often come to therapy as part of a manipulation (1999, p. 89).

Therapists commonly react with:

With adolescents, therapists may be charmed at first and drawn into treating the young person as an “exception” to the usual rules (Tanzilli & Sharp, 2026, p. 500). The PDM-3 advises that when uneasy feelings coexist with a history of violence, clinicians should put their own safety first (p. 694).

The field has argued about whether therapy can help at all. McWilliams says she has known many people with this style who were helped, while warning against grandiosity and urging careful assessment of treatability. She quotes Meloy’s critique of blanket “therapeutic nihilism” as “a mass retaliatory attitude where moral judgment impinges on professional assessment” (2011, p. 167). Following Meloy, she separates the role of evaluator from that of therapist, and she recommends a structured interview to judge whether therapy should be tried at all (pp. 167–168). The PDM-3 is more guarded, describing the prognosis as poor unless other personality tendencies coexist with the psychopathic ones (p. 694).

The approaches that help are unusual:

The PDM-3 frames this as working from a position of strength and appealing to the person’s self-interest rather than to a wish to grow (p. 694). Sympathetic mirroring, which soothes many people with a narcissistic style, tends to antagonize people with this one, and kindness may be read as weakness (McWilliams, 2011, p. 174; McWilliams & Shedler, 2026, p. 694).

Progress is measured in small things, and McWilliams treats each as a real achievement:

Since even a small move toward relatedness can prevent a great deal of suffering, she considers such progress worth the effort (2011, p. 172). Harold Greenwald reported that some of his long-term clients became seriously depressed in the second or third year of treatment, which he read as a sign that they had begun to care about him (pp. 170–171). Prospects are better at midlife and later (McWilliams & Shedler, 2026, p. 694).

Mentalization-based treatment, which targets the capacity to understand one’s own and others’ mental states, reduced anger, hostility, and paranoia in a small trial with people who had both antisocial and borderline diagnoses (Bateman et al., 2016). McWilliams adds that understanding someone is not an argument for leniency: the public still needs protection from people who are dangerous (2011, pp. 171–172).

Variations

How Different Thinkers See It

Cleckley: the mask

Hervey Cleckley’s The Mask of Sanity (1941) separated psychopathy from criminality. His sixteen-point clinical profile opens with superficial charm and good intelligence, the absence of delusions, and the absence of nervousness. It continues through unreliability, insincerity, lack of remorse, poor judgment, egocentricity and incapacity for love, and a general poverty of emotional reactions (Cleckley, 1988, pp. 337–338). For Cleckley the puzzle was a person who looks sane and even admirable but cannot feel the significance of what matters to others.

Aichhorn, Reich, and Winnicott: deprivation, impulse, and hope

Early analysts approached antisocial youth with curiosity rather than condemnation. August Aichhorn’s Wayward Youth (German edition 1925) applied psychoanalysis to delinquent youths in a reformatory, an effort Freud praised (Schowalter, 2000). Wilhelm Reich’s 1925 monograph on the “impulsive character” is often cited as the starting point for linking impulsive behavior to personality disorders (Perry & Körner, 2011). Winnicott, as noted above, saw the antisocial tendency as a sign of deprivation and of hope.

Kernberg: a continuum with narcissism

Kernberg placed antisocial personality at the far end of a narcissistic spectrum. Between ordinary narcissistic personality and antisocial personality proper, he placed “malignant narcissism,” which researchers in his group operationalize as grandiose narcissism plus paranoid tendencies, psychopathic features, and a sadistic, aggressive interpersonal style (Kernberg, 1989; Lenzenweger et al., 2018; McWilliams & Shedler, 2026, p. 688). His differential diagnosis of antisocial behavior also runs through other severe personality disorders with antisocial features, neurotic personalities with antisocial features, symptomatic neuroses, and “dissocial reactions” (Kernberg, 1989). A range like this, in effect, keeps the label from being applied to everyone who breaks rules. McWilliams accepts the continuum but argues that the two styles differ enough in treatment to deserve separate continua (2011, pp. 173–174).

Bursten and McWilliams: manipulation as the core

Bursten’s The Manipulator (1973) defined the style by its central pleasure: consciously “getting over on” others. McWilliams builds her account on this. She also lists inner indicators that she considers more useful to therapists than behavioral checklists: emotional insincerity, defects of conscience, contemptuous delight in getting over on others, attraction to extreme stimulation, lack of empathy, grandiosity, and reliance on omnipotent control (1999, p. 88).

Meloy: attachment and predation

Meloy’s The Psychopathic Mind (1988) describes a scarcity of deep identifications, first with a parent and later with society and humanity. McWilliams quotes and builds on this (2011, p. 163). McWilliams also draws on Meloy for the observation that a significant subgroup is planful and “predatory” rather than impulsive (1999, p. 114; 2004, p. 279), and for his warning to clinicians about their own retaliatory nihilism (2011, p. 167).

Hare and Lykken: the empirical tradition

Hare’s PCL-R (1991; 2nd ed. 2003) turned Cleckley’s portrait into a 20-item rating scale scored from 0 to 40 and became the standard instrument in forensic settings. Because it was developed with prisoners, it weighs criminal history more heavily than Cleckley did (Sanz-García et al., 2021). A meta-analysis estimated psychopathy at about 4.5% of the general adult population across instruments, but about 1.2% using the PCL-R (Sanz-García et al., 2021). Lykken’s 1957 study of anxiety laid the groundwork for his “low fear” model (Lykken, 1957; Costello et al., 2018).

There is a real disagreement here. Hare treats antisocial behavior as a necessary part of psychopathy, while others, in Cleckley’s spirit, see crime as a consequence rather than a defining feature (Abdalla-Filho & Völlm, 2020).

DSM, ICD, and PDM

DSM criteria trace back to the sociologist Lee Robins’s behavioral research. McWilliams notes that in DSM-IV only one of the seven criteria, lack of remorse, was internal (1999, p. 88). The PDM-3 instead describes inner experience, prefers the term “psychopathic,” and adds clinical guidance on countertransference and treatment (pp. 692–694).

Examples

Gifts instead of listening

McWilliams describes a patient with antisocial dynamics whose parents responded to her distress with extravagant presents, such as a stereo or a car, rather than by drawing her out and listening. She considers this kind of “generosity” especially damaging, because it left the patient no way to put into words her lingering sense that something was missing.

Nancy McWilliams, Psychoanalytic Diagnosis (2011), p. 163

The car thief who asked about a conscience

A colleague of McWilliams, known for her skill with clients who have antisocial dynamics, listened as a court-referred car thief excitedly described a nearly perfect heist. When he asked whether she would ever do something like that, she said no, for two reasons. First, life is never as controllable as a plan. Second, she had something he lacked: a conscience. He asked how he could get one. McWilliams uses the exchange to show how a therapist can be warm and humorous while remaining entirely incorruptible.

Nancy McWilliams, Psychoanalytic Diagnosis (2011), pp. 169–170

Scarlett and Rhett (fiction)

In a chapter on fictional characters, Cleckley compares Scarlett O’Hara and Rhett Butler in the novel Gone With the Wind. Rhett breaks more rules and might even fare worse in a tally of misdeeds, yet Cleckley finds him “warmly and deeply human.” Scarlett is more conforming, but she seems unable to respond to deep feeling in others when the most important personal matters are at stake. Cleckley says plainly that Scarlett would be a poor example of the full clinical condition. His point is that what defines it is an inner limitation, not a record of rule-breaking, and he adds that many people regarded as normal show milder versions of the same limitation.

Hervey Cleckley, The Mask of Sanity (5th ed., 1988), pp. 320–323

How It Differs From Look-Alikes

Narcissistic style
Both styles involve an empty inner world and dependence on outside events for self-esteem, and Kernberg places them on one continuum. Most people with a psychopathic style do not repeatedly idealize others, though, and most people with a narcissistic style do not rely on omnipotent control. Sympathetic mirroring comforts most people with a narcissistic style but antagonizes people with a psychopathic one (McWilliams, 2011, pp. 173–174). McWilliams adds that a more confrontational approach to grandiosity, of the kind Kernberg recommends, is received with more respect by someone with a psychopathic style (p. 193).
Paranoid style
Both styles are preoccupied with power, but from different positions. People with a paranoid style carry profound guilt, and working through that guilt is central to their recovery (McWilliams, 2011, p. 172). They are also deeply attached to others and capable of great loyalty. What threatens their relationships is a sense of betrayal, not an inability to love (pp. 232–233).
Dissociative style
A person with a basically psychopathic personality may use dissociative defenses, while a person with a dissociative personality may have a hostile or antisocial self-state. Both may distrust, comply on the surface, and undermine the therapy, the first out of omnipotent triumph and the second out of terror of abuse. The prognosis for the dissociative person is much better (McWilliams, 2011, p. 173).
Hysterical-histrionic style
Both can be dramatic, and gender stereotypes can push the same behavior toward one label or the other. People with a hysterical-histrionic style, however, are anxious, conflicted, and frightened. A show of the therapist’s power engages someone with a psychopathic style but intimidates someone with a hysterical one (McWilliams, 2011, pp. 328–329).
Addiction
Active addiction can make anyone manipulative and exploitive. Personality cannot be judged reliably until there is good information about the person before the addiction, or after a sustained recovery (McWilliams, 2011, p. 174).
Aging and brain disease
In later life, freedom from social pressure and a greater focus on the self are normal, and they are not psychopathy. Impulsivity and disregard for others can also be early signs of a neurocognitive disorder (Del Corno & Plotkin, 2026, p. 947).

History

Psychopathy was once called “moral insanity,” a term introduced by Prichard in 1835 (McWilliams & Shedler, 2026, p. 692). Schneider later described ten types of “psychopathic personality.” He used the term broadly for abnormal personalities that cause suffering to the person or to others, and he did not tie it to antisocial behavior (Abdalla-Filho & Völlm, 2020).

In the 1920s, Aichhorn and Reich brought psychoanalysis to delinquency and impulsivity. Henderson’s Psychopathic States (1939) distinguished passive and aggressive forms. Cleckley’s The Mask of Sanity (1941) shifted attention from crime to the inner deficit, and his book went through several editions.

From DSM-III (1980) onward, the American manuals defined antisocial personality disorder through observable behavior, relying heavily on Lee Robins’s research (McWilliams, 1999, p. 88). Critics noted that this lumped together people whose antisocial acts have very different meanings, and that it tilted toward people who are poor or marginal (McWilliams, 1999, pp. 88–89). Kernberg’s work in the 1980s placed antisocial personality on a spectrum with narcissism. Hare’s PCL-R (1991) gave research a common yardstick, and it has since been used in risk assessment for violence and reoffending (Sanz-García et al., 2021).

DSM-5 kept the behavioral category and placed a dimensional alternative model in its Section III (Helle et al., 2019). ICD-11 replaced personality types with severity ratings and trait domains, including Dissociality (Bach & First, 2018). Psychoanalytic writers went the other way on terminology: McWilliams follows Meloy in returning to “psychopathic,” drops “sociopathic” as dated, and uses the noun “psychopath” only for the extreme end (2011, p. 157). The PDM-3 also prefers “psychopathic” (p. 692).

Two controversies continue. The first is therapeutic nihilism: the belief that nobody with this style can be helped. The second is how much the concept should rest on behavior rather than inner experience. On the first, recent work, including research on mentalization-based treatment and findings that younger patients sometimes respond, has made the field somewhat more hopeful (Tanzilli & Sharp, 2026, p. 501; Bateman et al., 2016).

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