 The myth that psychopaths are fearless has been debunked for almost a decade in a slew of studies. And today we understand that most psychopaths actually experience anxiety, some of them even have anxiety disorder. Indeed my personal point of view is that psychopathy is a condition of hyper arousal over reactivity, hyper reactivity to anxiety and to fear. The psychopath's brain disables the centers of the brain that deal with fear and anxiety because there's a threat that the psychopath would be overwhelmed. The linkage between anxiety and psychopathy is well established. Not so the linkage between fear or the absence of fear and psychopathy a topic that is currently a hot button issue in psychology. I believe ultimately we will find out the psychopathy is a mechanism, a coping strategy or a coping mechanism that allows the psychopath to survive in high anxiety, fearful, terrifying environments by disabling parts of his or her brain, mostly his, most psychopaths are still men. There's a medical condition, it's known as obach-vite, obach-vite, obach-u-r-b-a-c-h, v-t-w-i-e-t-h-e, obach-vite disease named after the two doctors who have discovered it. And in this disease, there's an accumulation of fatty residues, cells, malfunction and a lot of fat accumulates throughout the body under the skin, etc., etc. And finally, reaches the brain, invades the brain, this fatty tissue accumulates in the brain and destroys the amygdala, the center of the brain that is in charge, among other things, of fear and arousal and emotions and other issues. So patients with obach-vite condition syndrome or disease are incapable of experiencing fear except the most basic forms of fear, like fear of drowning, or when in clinical experiments they are asked to breathe in carbon dioxide instead of oxygen, then they display fear. It's a kind of reptilian fear, if you wish, but otherwise they are fearless. And so many, many scholars and doctors and psychiatrists and so on have been comparing obach-vite patients with psychopaths, which is a serious mistake. It is true that the psychopath's amygdala, amygdalay, multiple, are actually less active than the normal person, but it begs the question, what precedes what? Does the dysfunction of the amygdala precede, or precedes, does it precede the psychopathy, or is psychopathy causing the brain's structural and functional abnormalities? That's the $64,000 question, and this is the core of the philosophy of neuroscience. We observe the brain, we analyze it, we record a variety of functional parameters, multi-unit activity and blood flows in fMRI and so on and so forth, but we have no way of telling what is the cause and what is the effect. Is the mental health condition the cause of the changes in the brain, or are the changes in the brain the causes of the mental health condition? And this applies to psychopaths as well. And today I want to share with you a recent study published in the academic magazine, Academic Journal, Personality and Individual Differences. It was published last month in March 2024. It's titled The Personal Cost of Psychopathy, Impacts of Triarchic Psychopathy Trades on Impairment, Internalizing and Life Satisfaction. The authors are Kelsey, Davis, Nicholas Kavish and Jaime Anderson. So it's a very interesting question because we all focus on the course of psychopathy to society, on the course paid by victims of psychopaths. But we never ask the question, what does it feel like to be a psychopath? What is the personal cost that the psychopath pays for his or more rarely her psychopathy? And this, as I said, is the topic of this study. So the new study is fascinating to read. It discusses the personal repercussions of living with psychopathic traits. Now, a caveat. The study has been conducted on undergraduate students, which is a unique cohort and many professors would tell you a bit weird. But anyhow, undergraduate students. And so it is not representative of humanity at large. It's a largely self-selecting sample because these are people who have chosen to study and then have chosen to participate in the research. And it's highly limited in terms of age, location, more Western and so on and so forth. So bear this in mind as we proceed. But the study tried to correlate psychopathic personality traits and individuals functioning across various domains. It tried to somehow discern or tweak out the impact of psychopathy on interpersonal relationships, internalizing behaviors, overall quality of life. Now, psychopathy is a constellation of traits and behaviors. Psychopathy is a behavioral relational social disorder, which brings many scholars to the realization that it's actually not a mental illness, not a clinical entity. It's more of a social dysfunction or actually perhaps a lifestyle or a social choice. The psychopath opts out of society. The psychopath chooses to defy authority, is contumacious, is defiant, is reckless and so on and so forth. These are character traits to a large extent. They even include a temperamental component, but is it a mental illness? It's highly debatable. Superficial charm, lack of empathy and remorse, manipulativeness, Machiavellianism, egocentricity, impulsivity, antisocial behaviors. They're not nice, none of this is nice, but it's any of this mental illness. I beg to differ, I don't think so. Psychopathy has been studied. It's actually the first mental health condition to have ever been studied. We have well over 200 years of studies of psychopathy, as I've repeatedly reminded you in previous videos over the years. But the main focus was the impact on society. The link between psychopathic traits, psychopathic behaviors, such as criminal behaviors, violent behaviors, aggressive behaviors and the unfortunate outcomes, the price that victims and targets and marks pay. But now there's a growing recognition that we need to understand the inner world of the psychopath, the same way some of us, myself included, have been trying to understand the inner world and the inner dynamics of the narcissist. How do these traits affect individuals who possess them? Do these individuals possess the traits, or do these traits possess the individuals? The authors of the study say, most psychopathic traits are generally undesirable, although this has primarily been asserted based on the consequences to society. The individual consequences may prove to be just as impactful. So the study based itself on what is known as a triarchic model of psychopathy, and this model breaks down psychopathy into three core dimensions. Boldness, daring, disinhibition and meanness being nasty, like me. So boldness has to do or is closely affiliated or related to fearlessness, social dominance, emotional resilience in the face of adversity. When you are high on boldness, you have a strong sense of self-confidence, almost a belief, a supernatural belief, that you are immune to the consequences of your actions. Boldness is a bit stupid, and there's a tolerance for the unfamiliar, for the risky, for the dangerous situations, events, people. And there's a capacity to remain calm, collected and assertive under pressure, even unusual pressure. This is boldness. Disinhibition is almost another word, almost a synonym of impulsivity, lack of restraint, poor behavioral control. Freud would have said that this is a manifestation of the id when the ego is not functioning. And this dimension of disinhibition reflects an inability, an innate inability, not a lack of will, but an inability, structural, constitutional, built-in, hard-baked, hardwired, baked-in inability to resist immediate, short-term temptations and opportunities. So it's opportunism that is risky and dangerous. Individuals that have high disinhibition struggle with planning, with foresight, and they act without considering the consequences of their actions. It brings to mind an alcoholic. Indeed, in alcoholism, we have a phenomenon known as alcohol myopia, when you act, the executive functions are out of control of higher functions, and so you act as if you were immune, as if you're untouchable, as if you're godlike. It's very common among alcoholics or people who have been drinking. And finally, the last dimension, you remember triarchic model, three dimensions, boldness, disinhibition, and the last dimension is meanness or nastiness, or some vakniness. It's a lack of empathy, disdain for close relationships, contempt of other people who are regarded as inferior and unworthy of consideration and compassion, a readiness to use and exploit others for personal gain, callousness, ruthlessness, gall orientation, which excludes the cost of other people as a relevant factor or a relevant consideration. And this dimension captures the uncaring and exploitative aspects of psychopathy, their callousness. Individuals with high level of meanness are indifferent to the harm that they cause to others. They engage in manipulative, deceitful, predatory behavior. They're often also aggressive, or at the very least passive aggressive. The authors say many previous studies have been limited by only reporting a total score of psychopathy or by utilizing a two-factor model. They are referring to Robert Hare's work. This study expands current knowledge by using the dimensional triarchic model by examining a person's specific variations in traits of meanness, boldness, and disinhibition. Insight can be gained into the potential impairments they may face. And of these three, it seems that the most problematic is disinhibition. Disinhibition is detrimental to the psychopathy. It is strongly and significantly associated with a range of negative outcomes across both studies conducted under the umbrella of this article. And so when the psychopath is disinhibited, he pays a heavy price. His impulsive, reckless behavior, which lacks foresight and foreplaning and premeditation sometimes leads him to pay an enormous price in terms of freedom, in terms of property, in terms of reputation, in terms of advancement, in terms of accomplishment. One way or another, impulsive, careless, reckless, cruel, callous, ruthless action leads the psychopath to diminishment, self-defeat, and self-destruction. Self-harm. It's a form of self-harming. And it raises a very interesting question about the connection between psychopathy and borderline. Borderline, people with borderline personality disorder, often self-harm. And when they self-harm, it's usually in the stage known as acting out where the borderline essentially becomes a secondary psychopath. So here's a linkage between psychopathy and borderline. It seems that impulsivity is the bridge that connects psychopathy and borderline. By acting impulsively without foresight, as if you're immune and untouchable, as if there's no tomorrow, you end up paying an extremely heavy price, one way or another. And individuals exhibiting higher levels of disinhibition experience, therefore, greater impairments in social and personality functioning. Reduce quality of life, cross multiple domains, physical, psychological, social, environmental. And they reported higher perceptions of impairment in cognition and life activities, such as work or school. So disinhibition plays a crucial role in the personal costs associated with psychopathy. And it affects the psychopath's ability to function effectively in various aspects of life. In short, disinhibition is the opposite of self-efficacy. It diminishes, reduces the psychopath's self-efficacy, the psychopath's ability to extract long-term beneficial outcomes from others and from his environment or her environment. Boldness is a more nuanced trait, a more nuanced dimension of psychopathy. There's more variability here. Boldness is linked to negative outcomes, of course. If you're daring, if you're stupidly daring, then it borders. It's almost impulsive, wouldn't you say? Daring and impulsivity are like first cousins or even siblings. But boldness also is linked to some positive outcomes, for example, or accomplishing things. So boldness is connected or correlated with a higher quality of life, a lower likelihood of self-harm, and therefore could lead an individual to become more self-efficacious. Unfortunately, in psychopathy, boldness is the outcome or highly correlated with challenged empathy and inability to be intimate, problems with intimacy. So the psychopath's boldness is because he cannot empathize, he cannot be intimate with anyone, he cannot resonate with another person. And so the psychopath sees no common denominator between himself and anyone else. It's the same way normal healthy human being view insects. The psychopath regards you as some kind of animal, a pet in the best case, an insect in the worst case. He either has to squash you, trample on you as he would an insect, or he has to control you and manipulate you as he would a pet, tame you, domesticate you. So these problems with empathy and intimacy cause the psychopath to be daring, bold, in your face, not only defiant, but defiant in a goal-oriented manner. And sometimes it brings positive outcomes. For example, the prevalence and incidence of psychopathy among the chief executive officers of Fortune 500 companies is five times higher than in the general population. Same applies to medical surgeons. Medical surgeons, there are many psychopaths among them, much more common than in the general population. And so this duality of boldness, that sometimes it's a good thing, and sometimes it's a bad thing, it means that boldness confers certain advantages. It's a kind of positive adaptation, or at the very least not an entirely negative adaptation. It enhances resilience. It is the cause of fearlessness, this daring, but it also impairs interpersonal relationships and prevents, inhibits emotional connections. Boldness is therefore a kind of inhibition, inhibition when it comes to empathy, inhibition when it comes to intimacy, inhibition when it comes to interpersonal relationships, inhibition when it comes to signaling vulnerability. So we have disinhibition, which is highly correlated with behavioral aspects of psychopathy, and we have inhibition in the form of boldness, which is highly correlated with the emotional landscape of the psychopath, including first and foremost his inability to empathize. And finally, meanness, nastiness. This is associated, not surprisingly, with a lot of interpersonal difficulties. This dimension of psychopathy contributes significantly to the psychopath's inability to function socially and problems in social interactions. But the relationship between meanness or nastiness and other aspects of personal well-being, such as quality of life, is not that straightforward. Sometimes being mean and nasty pays. It's a winning strategy. So there's variability, variability when it comes to the connection between meanness and nastiness and, for example, accomplishments, and accomplishments that lead to enhanced quality of life. In short, boldness and meanness sometimes work. Sometimes there are actually positive adaptations, the correct coping strategies, especially in environments that are hostile, unpredictable, dangerous, risky, unstable, indeterminate, such as our entire civilization right now. None of this applies to disinhibition. Disinhibition is simply stupid. It's self-destructive. It's self-harming. When you act impulsively without forethought and foresight, without analyzing what you're doing, then you're putting yourself in enormous danger. And you're likely, you're liable, you're bound to pay a price for this. And so this is inconsistency between one or two traits which are sometimes good, sometimes useful, sometimes positively adaptive, and a trait that is always negative. This inconsistency highlights the challenge in trying to understand psychopathy. Meanness and boldness, the effects of meanness and boldness are contingent on context, on culture, on society, on circumstances, on the environment, on other people. Disinhibition is always bad. But when we put the three together, we get a much more nuanced mosaic, nuanced kaleidoscopic picture of psychopathy, which is not entirely black and white. It makes it very difficult to split the psychopath, to say, psychopaths are all bad, we are all good. As the authors say, it appears that impulsive, antisocial, and disinhibited traits are most strongly associated with personal costs. Indeed, they have been tied to more significant impairment, reduced life satisfaction, increased internalizing, and high risk of self-harm and suicidality. Conversely, bold and fearless dominant traits appear potentially protective or more often unrelated to personal costs. Okay, I would like now to read to you excerpts from the study, because it's also an excellent introduction to psychopathy in general. In the literature, in the description, I'm sorry, you will find a link to the article, in the literature part. So the article opens with highlights. Highlight number one, a high disinhibition was the most impairing, triarchic psychopathy trait across functioning domains for undergraduates, I remind you. Number two, the personal effect of increased boldness varied, eliciting primarily positive, but some negative outcomes. Heightened meanness, nastiness, was primarily related to interpersonal difficulties. The authors say, although psychopathic traits have long been acknowledged as a public health concern, a growing body of evidence suggests there is a significant personal cost to living with psychopathy. However, much of the current literature on psychopathy impairment appears mixed in findings, varying by the traits examined and measured outcomes. The current paper aims to contribute to this field of research by examining how a triarchic model of psychopathy relates to a wide variety of potential consequences, including impairment, personality functioning, interpersonal functioning, internalizing and perceived quality of life. Through two studies utilizing the triarchic psychopathy model in undergraduate sample, significant psychopathy impairment was identified. Broadly disinhibition was related to the most significant impairments across functioning domains. Boldness was more variable and elicited both positive, higher quality of life, lower self-harm, and negative impairments in empathy and intimacy outcomes. Meanness was primarily related to interpersonal difficulties, however differences in measuring meanness led to different findings on its connection to personality functioning. By better understanding the consequences of psychopathy and how they vary by dimensional traits, interventions can be better tailored to alleviate both individual and societal suffering. And now I'll read to you the introduction which is, as I said, an excellent entry into the field of psychopathy. Psychopathic traits, say the authors, are increasingly recognized as a public health concern due to their connection with externalizing and antisocial behavior. Now each of these statements is followed by a bibliographic note, so I recommend that you read the article itself if you want to be exposed to many other points of view. So they say there's a connection of psychopathy to externalizing and antisocial behavior, largely focusing on the impact of psychopathy at a societal rather than personal level. However there's a growing evidence that some of these traits may pose a personal cost as well through impaired functioning, internalizing, and interpersonal difficulty. Despite the emergence of concerns, this realm of psychopathy-related personal consequences is still emerging, and additional evidence is needed to understand the nature of these traits and how they impact the individual. Part of the difficulty in understanding the personal cost of psychopathy lies in the ambiguity of psychopathy as a construct, say the authors. Although commonly associated with maladaptive personality traits and disorders, it has also been conceptualized as a constellation of traits rooted in the dimensions of normative personality. Additionally, other researchers have cited evidence of psychopathy being a developmental disorder, which can be predicted by significant genetic risk factors. Most modern researchers acknowledge that psychopathy is best understood as a multi-dimensional construct featuring correlated traits. However, which specific characteristics create the overarching construct is still debated. Generally, researchers agree there are typically problems in interpersonal, manipulativeness, superficial charm, affective, callousness, lack of remorse, and behavioral impulsivity and irresponsibility domains. This has been first identified by Cleckley, actually, in 1941, followed by Hare in 1996, and later, Patrick, and so on. Regardless of the specific definition of psychopathy used, it remains evident that most psychopathic traits are generally undesirable. Although this has primarily been asserted based on the consequences to society, the individual consequences may prove to be just as impactful. Intuitively, the most direct path to conceptualizing the personal cost of psychopathy would lie in impairment, some kind of impairment. However, say the authors, the pool of research assessing the relation between psychopathy and impairment is limited and mixed in findings. Broadly speaking, functional impairment has been connected to psychopathy. Miller, an ally, examined the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, newly introduced psychopathy-specifier as part of the Section 3 Diagnostic Model of Antisocial Personality Disorder. Consistent with prior, fearless, dominant, boldness research, the psychopathy-specifier was negatively correlated to both self and informant-related functional impairments. However, the components of the specifier demonstrated disparate findings. Level of impairment moderately increased as withdrawal and anxiousness increased. Attention-seeking was only weakly positively correlated with impairment. Now, say the authors, regarding specific facets of impairment, it would seem inherent that psychopathy is associated with empathy impairment. Psychopaths have been classically characterized as lacking empathy and remorse, often having attenuated responses to emotional stimuli. However, existing research across various fields, such as neurobiology and social psychology, has been characterized by mixed findings. Indeed, within offender populations, mayor-found, high-psychopathy scores were related to lower self-reported empathy, less altruistic behavior and an attenuated effective response to an empathy induction task. But in contrast, Domes and others found psychopathy was not associated with either cognitive or emotional empathy in offenders. Indeed, Borg and Sinot Armstrong assert current literature does not provide consistent evidence of psychopathy being associated with severe moral cognitive deficits. Research on intimacy impairment within psychopathy has yielded somewhat more consistent findings. One of the most intensive examinations of psychopathy's impact on intimacy found those with high-psychopathic traits tended to marry one another, and psychopathic traits predicted lower marital satisfaction and divorce. Similarly, in an undergraduate sample, psychopathy accounted for significant in-relationship factors, including overall relationship quality, commitment, satisfaction, romance, and trust for men and women. However, the relation between psychopathy and intimacy impairment can vary by which psychopathy traits are examined. Ali and Chamorro Premuzic found primary psychopathy characterized by traits such as lack of remorse, callousness, and manipulative behavior. Primary psychopathy was positively associated with relationship factors such as intimacy, commitment, and passion. However, secondary psychopathy characterized by impulsivity, aggression, and hostility negatively predicted intimacy. Overall, it appears that psychopathy can have an impairing impact on an individual far from the previous conceptualization that the traits may be purely beneficial or benign at best. However, the current findings, such as the differences seen between intimacy, empathy, and functional impairment, remain mixed and require further investigation. The authors say it is generally agreed that internalizing symptoms such as depression, anxiety, and withdrawal can have aversive and sometimes debilitating effects on those managing them. The connection between psychopathy traits and internalizing provides insight into additional personal costs. However, like impairment, this relationship varies depending on the psychopathy trait in question. Indeed, Lutzmann and others used a triartic approach to psychopathy, and they found that disinhibited traits were generally positively related to internalizing. Meanwhile, boldness traits were negatively associated with broad internalizing and specific internalizing subdomains such as dysphoria, suicidality, panic, and general depression. In juvenile offenders, internalizing and specifically trait anxiety was found to be positively related to higher levels of psychopathy and subsequent recidivism. Furthermore, Selbaum found evidence that certain psychopathic traits, for example fearless dominance, and so on and so forth, were negatively correlated with both negative affectivity and post-traumatic stress disorder symptoms in a university sample. PTSD in particular shows a complicated relationship with psychopathy. Blair and Mitchell suggested that, from a theoretical perspective, psychopathy should act as a protective factor from PTSD because patients with PTSD show heightened interference by emotional destructors as opposed to the reduced interference seen in psychopathy. Some empirical findings support this theory, as hospitalized men who scored higher on the psychopathy checklist showed a lower level of traumatic symptomatology, despite having experienced a higher number of traumatic events. By the way, I have a video here on the psychopathic self-state as a protector state, and I encourage you to watch it. The authors continue, however, when examined from a dimensional perspective, the relation between PTSD and psychopathy is less clear. Selbaum found impulsive antisociality was positively correlated with PTSD's symptoms, and fearless dominance was negatively correlated. Additionally, negative affectivity accounted for the majority of the shared variants for both sub-facets. However, although Kavish found a positive association between antisocial psychopathic traits and PTSD symptoms severity, they found no evidence of an association with the affective traits of psychopathy. Depression has also been examined as a correlate of psychopathic traits. In an undergraduate sample, psychopathy was associated with higher levels of depression and negative affect and lower levels of happiness and positive affect, nothing unexpected. Kavish and his partners also found a positive relation between antisocial psychopathic traits and depression symptoms severity. However, some researchers have asserted that individuals with higher levels of psychopathic traits are devoid of depressive symptoms. Indeed, Wiersman found psychopathy checklist revised scores in particular interpersonal, effective and lifestyle facets are inversely associated with depression scores in adult male prisoners. Like other forms of internalizing, suicidality was once thought to be the anesthesies of psychopathy, that incompatible with psychopathy, suicide, but empirical evidence, has suggested otherwise. Clickly, in 1941 and in 1976, described a defining trait of psychopathy to be suicide rarely carried out, in other words, suicidal ideation, and further suggested psychopathic individuals are immune to suicidality. However, several studies have reported a disparate relationship between psychopathy and suicidality. Often suicidality is positively related to impulsive antisocial traits, factor two, but negatively related or unrelated to effective interpersonal deficits, factor one. This relationship has also been examined through the interpersonal psychological theory of suicidal behavior. Overall, the existing evidence suggests that behavioral traits associated with psychopathy are particularly positively related to risk for suicide, while effective deficits are less or unrelated to suicide. There is also less evidence, relative to the literature, on other internalizing symptoms, that boldness, fearless dominance traits are protective against suicidality. The authors conclude, although notably less studied than internalizing symptoms, there is initial evidence of decreased life satisfaction in those with high psychopathic traits. In online and undergraduate samples, psychopathy accounted for a substantial portion of the overall variance in life satisfaction, with higher psychopathy predicting lower life satisfaction. However, in a sample of male offenders with psychiatric diagnosis, there were no significant differences in life satisfaction across the severity of psychopathy traits. Finally, Ali and Chamorro Premuzic found primary psychopathy was not significantly associated with life satisfaction, although the correlation was in the negative direction. However, secondary psychopathy negatively predicted life satisfaction. And this sits well with the hypothesis that the borderline is a psychopathic self-state, secondary psychopathy self-state, which predicts lower life satisfaction. Okay, back to the authors. A growing body of evidence suggests psychopathic traits are differentially related to an array of adverse outcomes. Current literature appears to demonstrate that impulsive and antisocial traits are generally associated with lower levels of function, greater impairment, reduced life satisfaction, and increased life-harming behaviors. Conversely, bold and fearless dominant traits seem protective against the same sequelae. Nevertheless, more research is warranted to further explore the replicability of these findings, etc. So, this is an excellent introduction to the current state of knowledge of psychopathy and runs contra to many of the nonsensical myths propagated online in classrooms, in universities, and even in textbooks. Psychopathy is not what we thought it is. It is closely associated with internalizing effects such as depression and anxiety. It is somewhat correlated with suicidality. Life satisfaction is low in some types of psychopathy. Some elements of psychopathy are actually positive adaptations, other and negative adaptations. It's a much more nuanced picture. And we need to realize that human beings cannot be captured with a single label, cannot be all bad or all good. That's a splitting defense. Even in the profession of psychology, in clinical psychology and psychiatry, we tend to split. Psychopaths are all bad, narcissists are all bad. We demonize, even in the profession. And we need to stop doing this. Human beings are multifaceted, even psychopaths, even narcissists. Human beings are layers upon layers upon layers of complexities upon complexities. Human beings are an archaeology site. Human beings are much more complex in the entire universe. The brain is the most complex object in the universe that we have ever come across or even conceived of. We can't reduce this to nine criteria or to a few sentences and paragraphs. We can't perceive human beings as one-dimensional caricatures or cardboard cutouts. We need to fan out. We need to begin to perceive nuance. We need to study a lot more. We need to be humble in the face of mental health and even more so in the face of mental illness.