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International Journal of and Psychiatry 54 (2017) 46–60

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International Journal of and Psychiatry
A new legal treatment for psychopaths? Perplexities for legal thinkers
Maria Isabel Gonzalez-Tapia a,⁎, Ingrid Obsuth b, Rachel Heeds b
a University of Cordoba, Spain
b University of Cambridge, UK
⁎ Corresponding author at: Facultad de Derecho y C
C) Puerta Nueva, s/n, 140071 Córdoba, Spain.

E-mail address: [email protected] (M.I. Gonzalez-Tapi

http://dx.doi.org/10.1016/j.ijlp.2017.04.004
0160-2527/© 2017 The Authors. Published by Elsevier Ltd
a b s t r a c t
a r t i c l e i n f o
Article history:
Received 15 February 2017
Accepted 14 April 2017
Available online 15 May 2017
Public perception, fueled not only by popular and news media but also by expert claims that psychopaths are ar-
chetypes of evil: incorrigible, remorseless, cold-blooded criminals, whose crimes manifest in the most extreme
levels of violence. But is there empirical evidence that psychopaths truly are what they are portrayed to be? If
so, should the law respond, and adjust its treatment of psychopaths in court — permitting psychopathy to be ad-
mitted under an insanity defense and/or resulting in mitigation? In this paper, we demonstrate that fundamental
questions from the law to science remain unanswered and must be addressed before any alternative treatment of
psychopathy can be considered. As it stands, psychopaths cannot be reliably defined or diagnosed and, as we will
demonstrate, even the presumed link with criminal dangerousness is problematic. We conclude that the current
legal approach should not be modified, however, if preliminary findings regarding impairments in impulsivity/
self-control are confirmed, some, but not all individuals who fall under one definition of psychopathy may
merit different treatment in future.

© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords:
Psychopathy
Criminal responsibility
Accountability
Insanity defense
Neuroscience
Contents
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
2. The concept of psychopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

2.1. Cold-blooded-unemotional vs. anxious-emotionally reactive individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
2.2. Primary vs. secondary psychopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
2.3. Successful vs. unsuccessful psychopaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

3. Mental insanity defense and reduced culpability at sentencing — differences and commonalities between common law and civil law . . . . . . . . 50
4. Accountability and psychopathy: key points of reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

4.1. The time of assessment of accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4.2. Biological requirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

4.2.1. Systems requiring diagnosable mental illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
4.2.2. Systems requiring just a mental anomaly or alteration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

4.3. Normative element: cognitive or volitional impairments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
5. Rethinking insanity defense? Emotion, human rationality and criminal responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Acknowledgement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
1. Introduction

The public has increasingly been given the message that ‘psycho-
paths are threatening, expensive and untreatable’. For example, in
CEE, Universidad de Córdoba,

a).

. This is an open access article under
2006, Babiak and Hare wrote (p. 17–18): “We now know that both
male and female psychopaths commit a greater number and variety of
crimes than do other criminals. Their crimes tend to be more violent…
and their general behavior more controlling, aggressive, threatening,
and abusive. Further, their aggression and violence tend to be predatory
in nature – cold-blooded… instrumental… and seldom followed by
anything even approaching normal concern for the pain and suffering
inflicted on others… Psychopathic criminals recidivate at a much higher
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47M.I. Gonzalez-Tapia et al. / International Journal of and Psychiatry 54 (2017) 46–60
rate, do so much earlier…and make up 15 percent of the prison popula-
tion. They are responsible for at least half of the persistent serious and
violent crimes committed in North America. Yet… not all psychopaths
turn to a life of crime, and not all criminals are psychopaths. Psycho-
paths can be just ‘snakes in suits’.”

These alarming claims, presented to the public by key experts in the
field as facts, are representative of the unsettling picture of psychopathy
currently developing in society. Fueled by increasing negative media at-
tention, these messages, along with mounting evidence for supposed
neurobiological markers of psychopathy, may influence, or may have al-
ready begun to influence, decisions made by policy makers and courts.
The question is: Is the concept of psychopathy clear enough and is
there currently sufficient empirical evidence to support these assump-
tions and to justify this influence?

In contrast to its treatment of individuals with diagnosable mental
health problems, based on official classification systems, criminal law
does not currently excuse or mitigate ‘psychopaths’. To date, the tradi-
tional view that psychopathy is not a mental disorder but a ‘way of
being’, a specific type of personality, persists in the majority of courts.
Thus, in the eyes of the law, psychopaths are ‘bad’ not ‘mad’. Psychopa-
thy is treated either as irrelevant, or as an aggravating factor due to the
very high level of criminal dangerousness traditionally associated with
it (see e.g., Rice & Harris, 2013).

In recent years, voices questioning the current legal treatment of psy-
chopathy have appeared in the literature (e.g., Gillett & Huang, 2013;
Godman & Jefferson, 2014; Nadelhoffer & Sinnott-Armstrong, 2012).
They criticize the current legal system on the grounds that advances in be-
havioral neuroscience and genetics have not been incorporated; they ad-
vocate a different approach to criminal responsibility for psychopaths
based on biosocial impairments. This would most likely result in more se-
vere legal treatment through ‘selective incapacitation’ and potential life-
long commitment (Morse, 2008b) commensurate with their greater dan-
gerousness (Coid & Maden, 2003; Luna, 2013), their difficulty engaging in
and responding to traditional psychotherapeutic or psychopharmacolog-
ical approaches, and the subsequent lack of successful treatment out-
comes (Polaschek, 2014; Salekin, Worley, & Grimes, 2010).

Psychopathy is a challenge for our socio-liberal, free-will and
culpability-based Criminal systems, because it represents archetypes
of ‘evil’, of incorrigible criminals, for whom a retributive culpability-based
punishment is not enough and a consequentialist ‘dangerousness-based’
legal response would be required. Whether under the name of ‘psychop-
athy’ or another name, this is an old and well-known problem for Crimi-
nal (at least since Lombroso, 1896; Ferri, 1881(1929); Garófalo,
1885(2005); or von Liszt, 1883). However, the scientific context is new,
and forces us to look at what the can learn from it. If neuroscience
and genetics have new information to offer, the should not be indif-
ferent, but open to considering pertinent developments and adapting
where necessary. In this paper we address this issue and, in so doing,
we also hope to contribute to elucidating any discrepancies between the
current ‘status quo’ (in terms of advances in research) and the informa-
tion distributed to the public.

As we will demonstrate, key questions from the law to science re-
garding psychopathy remain unanswered, arising in particular from
fundamental disagreements and contradictions in the basic definition
of the concept itself, which map onto two different profiles. In fact, de-
pending on whom one asks, psychopathy is (or is not) synonymous
with sociopathy and antisocial personality disorder (ASPD; Walsh &
Bolen, 2012). Moreover, parallel gaps and contradictions can be found
in the literature examining the biological markers of psychopathy. For
legal thinkers, this scenario leads to a genuine perplexity, where even
the dangerousness component of psychopathy needs to be clarified,
particularly because of the recognition of ‘successful psychopaths’
(who do not tend to be criminally dangerous) as a category.

We will conclude, that the current legal treatment, at least for ‘pri-
mary psychopaths’, should not be modified; the accepted presence of
‘successful’ psychopaths rules out any relevant mental alteration and
precludes a direct correlation with criminal behavior. We will also con-
clude that ‘secondary psychopaths’ might receive, in individual cases,
different legal treatment in the future, if the preliminary findings
pointing to impairments in self-control/impulsivity are confirmed.

Finally, it is important to highlight that this is a legal paper. Its aim is
to review the key scientific findings available to date, as well as identify
the outstanding questions from law to science to consider its findings
and to potentially inform normative solutions. It is not the goal of this
paper to provide an exhaustive review of the literature, make any new
proposals or theorize about the psychological concept of psychopathy
nor the proposed biological markers attributed to it by the literature.
Our purpose is, then, to assess whether the current legal treatment of
psychopathy is adequate or not; whether it takes into consideration
the findings of the contemporary scientific literature; and whether
any changes are warranted.
2. The concept of psychopathy

Before we discuss the legal requirements or criteria that ‘psychopa-
thy’ would have to meet in order to be considered in sentencing, it is
necessary to establish what the concept of psychopathy actually is.
The definition of psychopathy poses the first important difficulty. Psy-
chopathy is far from being a clear and generally shared concept, and
there is a lack of consensus regarding its distinctive features, or the un-
derlying psychological or neurobiological profiles. However, a clear def-
inition is essential for the , in order to properly apply the legal
requirements with respect to psychopathy or any other psychological
disorder or condition.

The most commonly used definition of a psychopath has been: a self-
centered, callous, remorseless individual, lacking empathy and the ability
to form close relationships; and a person who acts without the restric-
tions of a conscience, linked to a limited capacity to experience emotions,
such as fear and anxiety. Their only goal is the satisfaction of their own
needs, often through engagement in criminal behavior (Hare, 1991). Psy-
chopaths are also described as having intact cognitive capacity, being able
to distinguish between right and wrong, but lacking emotional empathy
and having diminished inhibitory control (Blair, 2005).

There is general consensus that the key personality traits of psycho-
paths are lack of emotional empathy and lack of a sense of responsibil-
ity, often referred to as Callous and Unemotional traits (CU). There is
also some agreement that antisocial behavior (not necessarily criminal)
is, at least, a behavioral outcome or recurrent manifestation of psychop-
athy (see Skeem, Polaschek, Patrick & Lilienfeld, 2011, for a review).
These traits also manifest through severe deficits in the ability to recog-
nize and experience social emotions; that is, positive or negative
emotions felt in relation to others, including shame, embarrassment,
guilt, empathy, and love, in addition to fear and sadness (e.g. Dawel,
O’Kearney, McKone, & Palermo, 2012). Experience of emotions seems
to focus and modify brain activity, leading us to choose cooperative,
long-term reward responses over cheating/manipulation and immedi-
ate rewards. It is this aspect which makes them crucial for regulating
and maintaining the balance between self-interest and group interest
(see Walsh & Bolen, 2012:156). As we will discuss later, this perspective
of psychopathy is relevant for a consequentialist criminal law, because
social emotions, and the ability to experience them, are essential in pre-
ventive strategies incorporated into the criminal justice system. These
rely primarily on the internalization of moral norms, through socializa-
tion and motivation, as well as deterrence through the use of punish-
ment, as a threat to deter people from engaging in criminal activity
(von Hirsch, Bottoms, Burney, & Wikström, 1999, for all). According to
Lykken (2000) and others (e.g., Mealey, 1995), lack of socialization in
‘primary psychopaths’ would arise from their inherent impairments,
whereas in ‘secondary psychopaths’ (for Lykken — ‘sociopaths’), from
a maladaptive early socialization environment, inconsistent parenting
and family violence in particular.

48 M.I. Gonzalez-Tapia et al. / International Journal of and Psychiatry 54 (2017) 46–60
However, there are several key points, which illustrate that funda-
mental disagreements and contradictions need to be considered (see
Skeem et al., 2011 for a general review). Two quite contradictory pro-
files for psychopathy have been described and further conceptual per-
plexity arises from the variety of terms employed to describe these
profiles.

2.1. Cold-blooded-unemotional vs. anxious-emotionally reactive individuals

With the exception of historic records, which are now believed to
have been referring to similar concepts (Pinel, 1806 “manie sans delire”,
for example; or Lombroso, 1896, “delinquente nato”… see Sass &
Felhaus, 2014), the first conceptualization of psychopathy was formu-
lated by Hervey Cleckley, in his seminal work “The mask of sanity”,
originally published in 1941 (5th ed. 1976). Here, Cleckley described
psychopaths as outwardly normally functioning individuals of average
to high intelligence, who fail to learn from their personal experiences
or to plan ahead. He further described them as individuals who do not
seem to experience anxiety, delusions or neuroses, they lack any signif-
icant concern about themselves or the impact of their behavior on
others, and show little, or superficial consideration for the feelings of
others, being consummate liars and having superficial charm. Note
that antisocial behavior, including criminal behavior, now commonly
associated with psychopathy, is absent from Cleckley’s description and
only originates much later from the conceptualizations of McCord and
McCord (1964) and Robins (1966). The fact that these studies were
based on offender samples may be a potential source of the discrepancy
where anti-social and criminal behaviors are concerned. The psycho-
pathic individuals observed by these authors had some emotional defi-
cits in common with Cleckley’s patients. However, they were also
described as hostile, callous, impulsive and aggressive, and exhibited
chronic antisocial behavior. Capturing these characteristics under a sin-
gle clinical diagnosis led to the inclusion of ASPD in the DSM-III
(American Psychiatric Association, 2013; Skeem et al., 2011).

Since Cleckley’s introduction of the term, several definitions, con-
ceptualizations and categorizations of psychopathy have been pro-
posed. Perhaps the most widely known to date is Robert Hare’s (1991,
2003) work. Through his Psychopathy Checklist (PCL; Hare, 1980) and
Psychopathy Checklist Revised (PCL-R; Hare, 1991, 2003), Hare initially
conceptualized psychopathy using a two factor model; his two factors
continue to be used to refer to the key aspects of psychopathy and to de-
lineate different types of psychopaths (described below).

Factor 1 — The Interpersonal/Affective domain includes callous and
unemotional traits such as: glibness/superficial charm; grandiose
sense of self-worth; cunningness/manipulativeness; lack of remorse
or guilt; emotional shallowness; lack of empathy; and failure to ac-
cept responsibility for actions.

Factor 2 — The Antisocial domain consists mostly of behavioral traits
associated with an antisocial lifestyle: a need for stimulation/prone-
ness to boredom; parasitic lifestyle; poor behavioral control; pro-
miscuous sexual behavior; lack of realistic long-term goals;
impulsiveness; irresponsibility; juvenile delinquency; early behav-
ioral problems; and revocation of conditional release.

Based on this initial characterization, taking into account the key
traits of Factor 2, psychopathy would be a clinical condition defined by
a combination of persistent antisocial behavior, marked sensation-
seeking, impulsivity and punishment insensitivity that emerges early
in life (Hare, 2003; Yang et al., 2015). Thus, PCL-R derived psychopathy,
perhaps because it was developed based on criminal samples, is more
consistent with the definitions put forward by McCord and McCord
(1964) (as mentioned in Skeem et al., 2011:101), than with Cleckley’s
original conceptualization.
Conversely, others (for example Cooke, Michie, Hart, & Clark, 2004)
have posited that it is the underlying personality features which charac-
terize Factor 1 (such as interpersonal grandiosity and deficiencies in affec-
tive experiences and empathy) which are key to the conceptualization of
psychopathy and that behavioral problems, consistent with Factor 2, are
better understood as consequences of these traits. Given failed attempts
to replicate the original two-factor model, Cooke and Michie (2001) pro-
posed a three-factor model of PCL-R psychopathy and subsequently,
aiming to better capture a psychopathic personality, Hare (2016) intro-
duced a four-factor model. In the three factor model, the original Factor
1 is sub-divided into Factor 1 (affective deficits) and Factor 2 (interper-
sonal deficits), and behavioral deficits are included in Factor 3. Notably,
in the three-factor model the five items measuring criminal behavior
were discarded. In the four-factor model, those five items were retained
and included in Factor 4 (criminal behavior). The currently favored
four-factor model has been widely utilized and validated (e.g., Weaver,
Meyer, Van Nort, & Tristan, 2006; Zwets, Hornsveld, Neumann, Muris, &
van Marle, 2015). Person centered analyses based on the four-factor
model have also been carried out (e.g., Neumann, Vitacco, & Mokros,
2016) and yielded four different offender profiles described as: 1. a psy-
chopath group — scoring high on all four PCL-R factors; 2. a callous-con-
ning group — scoring high mainly on the Interpersonal and Affective
factors; 3. a sociopathic offender group — scoring high mainly on the Life-
style and Antisocial Factor; and 4. a general offender group — scoring low
on all factors.

Moving away from the PCL-R as a key diagnostic and definitional
tool, Lynam and Widiger (2007) have proposed a conceptualization of
psychopathy within the framework of the five factor model of personal-
ity functioning (FFM; Costa & McCrae, 1990). The FFM includes the fol-
lowing five dimensional personality characteristics: neuroticism,
extraversion, openness to experience, agreeableness, and conscien-
tiousness. Based on their analyses of the characteristics underlying
these five dimensions, Lynam and Widiger (2007) proposed 12 charac-
teristics as representing the core features of psychopathy. According to
these authors, a ‘prototypical’ psychopath would score low on five facets
of agreeableness (straightforwardness, altruism, compliance, modesty,
and tender mindedness), three facets of conscientiousness (dutifulness,
deliberation, and self-discipline), one facet of neuroticism (self-consci-
entiousness) and one of extraversion (warmth). In addition, such a per-
son would score high on impulsiveness (from the neuroticism factor)
and excitement seeking. Based on these characteristics, a team of re-
searchers also developed a five-factor model rating form (Mullins-
Sweatt, Jamerson, Samuel, Olson, & Widiger, 2006), which has been
used in research on psychopathy (e.g., Beaver, Hartman, & Belsky,
2014; Miller & Lynam, 2015) and subsequently the dimensional concep-
tualization of psychopathy, including the psychopathic personality in-
ventory has been used to develop further scales (PPI; Lilienfeld &
Fowler, 2006). The Triarchic Model of psychopathy (Patrick, Fowles, &
Krueger, 2009) defines psychopaths based on possessing varying de-
grees of three distinct observable (phenotypic) characteristics: boldness
(or fearless dominance), meanness, and disinhibition (Skeem et al.,
2011).

The above conceptualizations/definitions of psychopathy all paint
slightly different pictures of who a psychopath is or is not. Indeed, if
there was consistency multiple definitions would not be necessary.
While there is some overlap, there are also many differences and several
contradictions. For instance, while the PCL-R focuses on the antisocial
personality, exhibited primarily through antisocial behavior, the con-
ceptualization based on the FFM model does not include engagement
in this behavior. There also seem to be different types of psychopaths
(see also, Koenigs, Kruepke, Zeier, & Newman, 2012 and below). These
differences are of key importance to the law, for two main reasons:
first, if they are to be considered as definitional features of psychopathy,
including antisocial behavior, it should be possible to connect the type
of offense and behavioral expression (instrumental or impulsive aggres-
sion, for instance) with the specific type of disorder, as this is a

49M.I. Gonzalez-Tapia et al. / International Journal of and Psychiatry 54 (2017) 46–60
requirement for the insanity defense or for mitigation (as we will ex-
plain below); and second, it would also be consistent with the common
association between psychopathy and criminal dangerousness.

In addition, based on this conceptualization, it seems clear that indi-
viduals scoring high on the items assessing the antisocial component
(Factor 2) are significantly more diverse than those who score high on
the interpersonal/affective domain (Factor 1). For this reason, some
researchers have questioned whether Factor 2 (primarily violent)
individuals are truly psychopaths or not. For example, Skeem et al.
(2011), queried whether “anxious and emotionally reactive people,
that are identified as psychopaths by the PCL-R” are truly psychopaths
(p. 104). We believe this to be a pertinent question, given the radical dif-
ferences between the underlying temperamental profiles of Factors 1
and 2, and between Cleckley’s and McCord and McCord’s respective
conceptualizations of psychopathy. Skeem et al. (2011) point out that
the interpersonal–affective factor (Factor 1: subdivided into interper-
sonal and affective facets) linked to ‘primary’ psychopathy (see below
for more about this distinction), is associated with fearlessness, narcis-
sism, low emotional empathy, and social dominance and is inversely as-
sociated with negative emotionality. In contrast, the antisocial factor,
linked to ‘secondary’ psychopathy (Factor 2: also divisible into impul-
sive–irresponsible lifestyle and antisocial behavior facets) is associated
with negative emotionality, impulsivity, frustration, general sensation
seeking, substance abuse and reactive aggression (Skeem et al., 2011;
p. 119). Importantly, impulsivity and reactive aggression (see Blair,
2010b), associated with Factor 2, seem to be the core features of second-
ary psychopathy. ‘Primary’ psychopaths, however, are presented as
“emotionally stable” (see Skeem et al., 2011; p. 119; Snowden & Gray,
2011). In addition, when looking at the PCL-R, Factors 1 and 2 are only
moderately positively correlated and, importantly, they show correla-
tions in opposite directions with external variables, such as anxiety.
Moreover, only Factor 2, consistent with ‘secondary’ psychopathy,
would predict future delinquent and antisocial behavior (see Skeem
et al., 2011; Yang, Wong & Coid, 2010) which is consistent with risk-
based explanations of aggression and crime (Farrington, 1985), suggest-
ing that it is past behavior and not psychopathic features (Factor 1 and
consistent CU traits) that best predict future engagement in similar be-
havior. Again, these contradictory profiles underlying the same categori-
cal definition are highly relevant for the . As we will explain later,
only deficits in self-control are currently relevant, and only in some
legal systems, for insanity defense or mitigation. Yet based on the litera-
ture available thus far, not all psychopaths show volitional impairments.

Recently, even more approaches to defining psychopathy have
emerged, however, these do not seem to solve the existing problems
but open up new discussion. For example, currently, there is overall
consensus in the literature that psychopathy should be considered as
a dimensional, rather than a categorical construct (e.g., Guay, Ruscio,
Knight, & Hare, 2007; Hare & Neumann, 2005, Hare & Neumann,
2008; Lynam & Derefinko, 2006; Patrick et al., 2009). Psychopathy is un-
derstood as a question of degree and not, at least completely, as categor-
ical/taxonomical. In other words, what matters is the degree of
psychopathic characteristics that an individual exhibits, rather than
whether they are indeed ‘a psychopath’ or not, or whether they could
in fact be classified as something else. Ironically, while the dimensional
view of psychopathy has been gaining in popularity, experts in the field
(e.g., Hare, 2016) have highlighted the existence of a category of severe
or “hardcore” (Guay et al., 2007; p. 1589) psychopaths at the top end of
the continuum. Focusing on this sub-group may enable the reconsider-
ation of the prevalence of ‘psychopathy’ in society and its real impact.

A dimensional view perhaps increases the likelihood of those with
characteristics of psychopathy which are not unique and are therefore
shared with other disorders (such as autism, ADHD, ODD or ASPD)
meeting criteria for psychopathy. This is not only conceptually confus-
ing and clinically counter-productive, it also leaves use of mitigation
or insanity defense based specifically upon psychopathy impossible —
as those who qualify as psychopaths under this definition may in fact
not be. However, the dimensional approach could have advantages in
the context of the legal system as it could be used to base legal criteria
upon discrete types of impairment (which may be common to multiple
disorders) rather than on specific disorders. As such, it could be more
likely to open the door for an insanity defense or to mitigation for
unspecified disorders than a categorical interpretation would be. It
also allows for the identification of pathological personalities with im-
pairments relevant to criminal liability. A dimensional view of psychop-
athy has also led to the search for multiple causal factors that contribute
to the development of psychopathic features, instead of a focus on find-
ing the one underlying cause (Murrie et al., 2007). In our opinion, how-
ever, in spite of the posited advantages of the dimensional perspective,
the key question of whether there are actually two distinct versions of
psychopathy remains (see Walters, 2015).

2.2. Primary vs. secondary psychopathy

The distinction between primary (born/fearless-cold-blooded) and
secondary (made/anxious–impulsive) psychopaths is another well-
known distinction made in the psychopathy literature. The two types
of psychopaths have shown …