ALMOST A PSYCHOPATH ALMOST A PSYCHOPATH Do I (or Does Someone I Know) Have a Problem with Manipulation and Lack of Empathy? Ronald Schouten, MD, JD, Harvard Medical School James Silver, JD Hazelden Center City, Minnesota 55012 hazelden.org © 2012 by Harvard University All rights reserved. Electronic edition published 2012. Produced in the United States of America. Ebook ISBN: 978-1-61649-426-1 No part of this electronic publication, or its printed work, may be reproduced in any form or by any means without the written permission of the publisher. Failure to comply with these terms may expose you to legal action and damages for copyright infringement. Library of Congress Cataloging-in-Publication Data Schouten, Ronald. Almost a psychopath: do I (or does someone I know) have a problem with manipulation and lack of empathy? / Ronald Schouten, James Silver. p. cm. — (The almost effect series) Includes bibliographical references. ISBN 978-1-61649-102-4 1. Antisocial personality disorders—Case studies. 2. Psychopath—Case studies. I. Silver, Jim, 1963-II. Title. RC555.S36 2012 616.85’82—dc23 2012004423 DSM–IV–TR Criteria reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (copyright 2000, American Psychiatric Association). Editor’s notes: The case examples in this book are drawn from media accounts or are composite examples based upon behaviors encountered in the authors’ own professional experiences. None of the individuals described were patients or legal clients. The names and details have been changed to protect the privacy of the people involved. This publication is not intended as a substitute for the advice of health care professionals. 17 16 15 14 13 12 1 2 3 4 5 6 Cover design by Teresa Jaeger Gedig Interior design and typesetting by Kinne Design Harvard Health Publications HARVARD MEDICAL SCHOOL Trusted advice for a healthier life The Almost Effect™ series presents books written by Harvard Medical School faculty and other experts who offer guidance on common behavioral and physical problems falling in the spectrum between normal health and a full-blown medical condition. These are the first publications to help general readers recognize and address these problems. To my mother and my late father R.S. To my mother and the loving memory of my father J.S. contents Series Foreword: The Almost Effect Acknowledgments Part 1: Minor Problems to Major Predators Chapter 1: Setting the Stage Chapter 2: What Is a Psychopath? Chapter 3: The Almost Psychopath Chapter 4: Could It Be Something Else? Part 2: Dealing with Almost Psychopaths in Our Lives Chapter 5: Living with an Almost Psychopath Chapter 6: Recognizing Almost Psychopathic Traits in Children Chapter 7: Working with an Almost Psychopath Chapter 8: Confronting Child Abuse by Almost Psychopaths Chapter 9: Adults as Victims: Confronting Almost Psychopaths in the Helping Professions Chapter 10: Sick or Slick? Malingering and Manipulation of Illness Chapter 11: What to Do When You Find Yourself in Almost Psychopath Territory Appendix A: Diagnostic Criteria for Antisocial Personality Disorder Appendix B: Defining a Mental Disorder Using the Axes of the Diagnostic and Statistical Manual of Mental Disorders (DMS–IV–TR) Notes About the Authors series foreword The Almost Effect I once overheard a mother counseling her grown daughter to avoid dating a man she thought had a drinking problem. The daughter said, “Mom, he’s not an alcoholic!” The mother quickly responded, “Well, maybe not, but he almost is.” Perhaps you’ve heard someone, referring to a boss or public figure, say, “I don’t like that guy. He’s almost a psychopath!” Over the years, I’ve heard many variations on this theme. The medical literature currently recognizes many problems or syndromes that don’t quite meet the standard definition of a medical condition. Although the medical literature has many examples of these syndromes, they are often not well known (except by doctors specializing in that particular area of medicine) or well described (except in highly technical medical research articles). They are what medical professionals often refer to as subclinical and, using the common parlance from the examples above, what we’re calling the almost effect. For example: Glucose intolerance may or may not always lead to the medical condition of diabetes, but it nonetheless increases your risk of getting diabetes—which then increases your risk of heart attacks, strokes, and many other illnesses. Sunburns, especially severe ones, may not always lead to skin cancer, but they always increase your risk of skin cancer, cause immediate pain, and may cause permanent cosmetic issues. Pre-hypertension may not always lead to hypertension (high blood pressure), but it increases your risk of getting hypertension, which then increases your risk of heart attacks, strokes, and other illnesses. Osteopenia signifies a minor loss of bone that may not always lead