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The word “psychopath,” like many words associated with mental and personality disorders, is used broadly, and often incorrectly — colloquially, we might call someone who lies a lot a psychopath, just as we might call someone who texts us more frequently than we want “crazy.” The word “psychopath” is also routinely used to describe serial killers, though not all serial/mass murderers have psychopathic personalities. And while “sociopath” is sometimes (mistakenly) used interchangeably with psychopath, only the latter is rigorously defined and clinically accepted, says Craig Neumann, a professor of Clinical Psychology at the University of North Texas whose singular research focus has been the psychopathic personality and its traits.

According to Neumann, the true definition of “psychopath” is actually pretty narrow: “Broadly speaking, psychopathy refers to a pathological personality style that is interpersonally deceptive, affectively cold, behaviorally reckless, and often overtly antisocial,” he writes. To qualify, he says, a person must possess traits pertaining to each of four “domains”: Interpersonal, Affective, Lifestyle, and Antisocial. The corresponding traits are as follows:

Interpersonal: They’re manipulative, deceitful, and/or narcissistic.

Affective: They lack remorse, are callous, and may take pleasure in hurting others.

Lifestyle: They’re impulsive, may use illegal substances, and may have disregard for the consequences of their actions.

Antisocial: They are physically aggressive and may have a history of or tendency toward criminal behavior.

Importantly, Neumann notes, psychopathy is a scale. “It’s not that you’re either a psychopath or not,” he says. “In the same way someone can have severe depression but it’s also possible for someone to have mild or moderate depression.” Neumann uses the example of professional poker players: they might be deceitful, and narcissistic, but they’re (probably) not psychopaths. Similarly, he takes issue with neuroscientist James Fallon’s calling himself a psychopath because his brain imaging profile matched that of psychopathic individuals.

“Just because the amygdala shows hypoactivation does not make you a psychopath,” says Neumann. “This is a characteristic that’s associated with psychopathy, but biology is not destiny. We believe that the syndrome, the personality disorder, is a coming together of these four major domains.” While certain people may possess a few, or even most of the psychopathic characteristics (like superficial charm, sexual promiscuity, and early behavioral problems, to name a few) listed on the Psychopathy Checklist (the PCL-R) — another tool used in the diagnostic process — unless they fulfill each of the four domains, Neumann doesn’t consider them truly psychopathic.

“The max score on the PCL-R is a 40, but to reach 30 is really going to be up there,” he says. (Most people score between a 1 and a 3, he adds.) “But the point I’m trying to make here is that even people who are 25, 26, they don’t quite reach the diagnostic threshold. Even people who are 16, 17, 18 on the PCL-R are nasty sons of bitches. Do they meet the diagnostic threshold of what we would call meeting a diagnosis of psychopathy? No.”

Neumann hasn’t met or spoken to the subject of the following interview, but he did offer some potential disclaimers when I described the nature of our conversation. “These people dissimulate, they lie quite regularly, so it’s a challenging interview to do,” he says. “And most individuals at very high levels of psychopathy are not going to submit to an interview.” He’s also insistent that psychopaths are inherently and evidently unpleasant to be around. “One of the essences of personality pathology is you usually feel it in your gut first. Would I get in a car with this person and drive across the United States? And if you say ‘Oh, hell no,’ that gives you a clue that there’s something off in terms of personality,” he says.

The woman I spoke to, who will remain anonymous, says she was diagnosed as a psychopath in her mid-20s, and the diagnostic process she describes appears to be in line with what Neumann says is required. That said, our conversation was under an hour, and I am not a psychologist. That conversation, which has been edited for length, is below.

When were you diagnosed as a psychopath?

From age 26 to 27. I went through the whole diagnostic process over several months. There were a certain number of doctors that were involved, and a lot of testing: neuropsych testing, personality testing, brain scans, a lot of different interviews and going through the history of my childhood. It wasn’t a quick snap diagnosis. It was something that was arrived at over a decent period of time.

What precipitated that decision to start looking into a diagnosis?

Well, when I was younger I had some youthful indiscretions that I don’t go into. But I had gotten [an evaluation] as a teenager, and had no idea what the result of that was. But when I got a little older, it just — I’d always known my whole life I was quite different in how I trust people, how I thought about things, how I experience the world. I actually ended up contacting the same doctor who did the first workup. And he remembered me, which I thought was interesting. He said, “Well, let’s just start from scratch,” which I was actually interested in doing. I wanted to know: why is my experience so different? Why do I not comprehend the basic interactions that, for other people, it just seems to be natural for them?

I had no idea what it was going to evolve into. I didn’t know it was going to be months of testing. I think there were a few times where I was ready to not care anymore, but I kept with it for some reason. At the end of it, he was a very smart person. I think he’d probably known someone else that was on the psychopathy spectrum, so he wasn’t immediately judgmental. He didn’t automatically give me the rundown of criminals, or what a lot of people assume psychopathy to be. He was able to actually talk to me about it. Once he explained it to me, it was: oh! Oh, all right. That makes sense.

Let’s talk about what people get wrong about psychopaths, in your view. Especially now, when there’s this huge cultural true-crime obsession, I think we have this very particular understanding of what a psychopath means, and it’s almost universally someone who’s very violent.

It’s actually not an unreasonable thing — not because it’s true, but because of what they’re presented with. Most studies done on psychopaths are done [on men] in prison or in forensic hospitals, so everything you’re going to hear is going to come from a criminal. It’s always going to be painted against the backdrop of someone who has committed crimes. They’re only out for themselves, they don’t care about anyone else. If you interviewed any walk of people, and based their entire profile based on [the institutionalized] version of that person, like neurotypicals or autistic people, bipolar people, you get a very different picture than if you interviewed them in their general lives.

There is also this mistaken thinking that all serial killers are psychopaths, which is just not even remotely true. It’s just a myth that won’t die. There’s a phrase: “Not all psychopaths are serial killers, but all serial killers are psychopaths.” It’s just incorrect. But people hear this, and they associate [us with] serial killers. For some reason, people think we want to kill people. And I think that probably comes from the lack of empathy. People believe that if you have a lack of empathy, that automatically opens a floodgate of antisocial behavior. That’s not really how it works. I may not care, I may not have an emotional reaction to someone’s pain, but that doesn’t mean that I’m going out of my way to cause pain. It just means that I don’t have that emotional response.

In a day to day sense, or in your interpersonal relationships with people, is empathy or attempted empathy something you’ve had to teach yourself in order to relate to other people? How does that work?

Well, we have cognitive empathy. So if your mother died, I can look at you, I can see that you are in pain. I may not feel the same pain, but I can understand you feel pain, and that series of behaviors usually warrants a certain response: comfort or interaction, engagement. And so it’s a matter of honing that over time, and also making sure that I can continually consider that my reaction to things is not how other people experience things. Which is hard, because you sort of go through life with the assumption that everybody experiences it like you do.

Do you ever feel afraid?

We don’t feel fear. We get adrenal responses. When you have adrenaline responses to a car accident, or bungee jumping, or what have you, we’ll still get that, but for us, we don’t feel the fear, which can be obviously dangerous if you’re a little kid, and you don’t know you’re supposed to be afraid of stuff. We don’t process the emotion of fear. It doesn’t occur to us. And we can’t understand it, either. I mean, we get that you feel something, but we don’t get it.

How do you perceive it when you hear someone expressing their fear of mortality, or says they’re afraid to die someday? That always baffles me, because I can’t comprehend why it matters. For me, life is very much in this immediate moment. This moment is all you have, and the fear of it going away is just nonsensical. This is a huge disconnect for me. People explain it in ways that they very much understand: they’re afraid of dying, they’re afraid of not being important, they’re afraid of being forgotten. And none of those things are important to me, so it’s sort of like saying I’m afraid of not being the color blue.

In your romantic relationship, does that present a challenge as far as talking about values, or knowing what to do when someone wants sympathy from you?

Certainly. I’ve been with my partner for 19 years, and he’s been with me through the whole diagnostic process, and it’s definitely been a learning curve. He’s probably one of the most patient people you will ever meet on the planet. He reads people and he understands people on a level I simply don’t. Through learning from him, I actually can apply that back to him, and understand what his needs are. It’s always a conscious effort. I know that for a lot of people, their significant other is more important to them than themselves. They think of them first, that sort of thing. That will never be natural for me. I always have to make sure I am manually considering him. There are certainly things that I miss, and it requires me to have to do bimonthly maintenance. Am I hitting all the marks for you? Do I need to do anything differently? Where am I not fulfilling what you need? And usually he’s like “eh, it’s fine.”

To be honest, that sounds like a wise practice for most people. I think a lot of people take it for granted that the other person knows where they’re at.

I agree with you. I call it cognitive love. And it’s investment. You have to make that investment, you have to make the time, you have to take the other person into consideration all the time. It’s important. His needs are on the same level as mine — which, if you knew me, you would know that that’s very, very rare.

When you say cognitive love, does that mean you don’t feel that sort of romantic roller coaster feeling that other people describe to you?

Well, no, I don’t. Certainly attraction. I feel attraction, and he’s very attractive. But psychopaths don’t process oxytocin like neurotypicals do. What oxytocin contributes to in your brain is chemical love, so that feeling of a roller coaster. Bonding is another one we don’t have. You bond to your significant other, you bond to your children, you bond to your pets. There’s also trust, which is a weird one, because I didn’t know oxytocin had anything to do with trust. Most people feel trust as an actual emotion. I never knew that. To me, trust was always: You show me how you’re going to behave, and I will determine whether or not I want you around. I always knew I didn’t trust people, and I always had a disconnect, because I didn’t know it was a chemical reaction for most people. I didn’t have an explanation as to why I didn’t trust people, but then I started digging into oxytocin. It made sense.

A lot of people think of psychopaths as having a very flat emotional affect, and I know we haven’t talked for long, but that’s not my impression of you. You obviously have a personality, and a distinctive way of speaking, and so I wonder what your experience is with that perception.

People think we have no emotion, which is absolutely not true. We just feel them way turned down. If most people feel an emotion between seven and eight on a dial of ten, I feel it between zero and two. Negative emotions are background noise. We can’t tune into that frequency because our brains just don’t process enough information for them to ever be loud enough to feel or direct behavior. We enjoy things, get excited about things, like adrenaline — that’s great. I laugh with people, I enjoy intellectual discussions. A lower functioning psychopath probably wouldn’t enjoy intellectual conversation. They’d rather go and rob a liquor store. But that’s why they spend most of their lives in prison.

Do you feel at all that your psychopathy is an advantage to you? Do you feel lucky in any sense?

No. It’s not an advantage, because all neurotypes come with limitations, don’t they? With psychopathy I constantly have to figure out people, and why they do what they do, and how to respond to them. Normal people have to deal with grief and loss and pain and heartbreak, but they also have things to make them happy. I think people are pretty wired the way they’re meant to be. I don’t know that it’s necessarily an advantage or disadvantage, it’s just what you make of it. I could easily take psychopathy and make it a terribly negative thing for both me and the world, because I could make bad choices, and do terrible things. I could do that, but that’s not who I have any interest in being. Anyone can make bad choices for themselves.

Do you still see the doctor who diagnosed you, or do you sort of have any regular treatment that you do?

It’s completely self managed at this point. There’s really nothing to manage. I learn about it by reading studies. I haven’t spoken to [that doctor] since back when I got the diagnosis. It was pretty much, “Thank you very much,” and that was the end of that. We never spoke again.

And you don’t take any medication for it, right?

No. It’s just a variant brain structure. And actually we respond very differently to medications as well, because our chemistry is different, so you can expect strange medication reactions. I’ve been dealing with that. Whenever a doctor prescribes the medication, I can pretty well expect it to not work as intended.

Does that apply to something as innocuous as a cold medication?

Yeah. Sometimes cold medicines work for things like decongestants, but things like pain medication, I’ve never experienced the high that other people get. I have no comprehension of why people enjoy opioids. We also can’t get addicted to things because of the way our brain works. There are psychopaths that use drugs, but you can cut them off cold turkey and they will not have any withdrawal. They don’t have any cravings, and they can just go on with their day like it was nothing. That’s another weird chemical processing. So we just lack certain normal cues that other people have.

Online you’re very out as far as being a psychopath but is it something that a lot of people in your personal life know? Or your family?

No. They have no idea, and I’m going to keep it that way.

Do you have a relationship with your parents?

Yeah. They’re great people. They don’t know. They had a really difficult child to raise in me, and I’ve gotten older, and to them, I’ve matured into the daughter that they always wanted. I don’t really see a need to change their perceptions of things. They know me for what they need to know me for. Trying to explain psychopathy to people, especially older people, is really difficult.

With a lot of diagnoses I think the assumption would be that the more information your parents or your family or whoever has, the better they will be able to understand you, but obviously you don’t feel that way.

Well, sure, but then you’d have to have them dive into neurology, biology, understanding the wiring of the brain. And the word has so much negative stigma. Most of the time when you say “psychopath,” people immediately have a very specific reaction, and they shut down. They have absolutely no interest in hearing past evil, dangerous, killer, malicious, out to get you. The things people assume about psychopathy are crazy. Trying to explain that to someone when you’re their daughter, and they think of you as someone they know, they love, they trust, that’s going to upset their entire perception. And you may never get it back. It’s a huge risk and not one I really have any interest in taking.

When you meet new people, whether professionally or personally or whatever context, do you present them with the version of yourself that fits the situation?

Absolutely. Why tell them anything that they don’t need to know? They just need to know what they can expect of me.

Do you think it’s something that people suspect about you? Or do you think people’s perceptions are so off that they wouldn’t really know what psychopathy looks like?

No. Psychopaths use what we call a ‘mask.’ It’s basically an entire affectation of being like everyone else. We learn at a really young age that if we respond to things the way that we naturally respond to things, people don’t like that. So you just learn how to affect the behavior and how to appear like everyone else, and that’s just what you have to do.

There’s a very different version of me that goes out of the house and interacts with the world from the person who’s home with people who know how I actually am. And even with the people who do know me, and do know how I actually am, there still has to be a mask. If somebody’s spending time with me in a room, I won’t give them the impression that they’re welcome. They might say something to me, and I’ll answer them back, but I’m not going to look at them, there’s no feeling of being welcome. But to me, unless I tell you to leave, you’re completely welcome.

I have a friend who will feel like I resent her spending time with me. She’ll be like, “I’m bothering you.” You’re not bothering me. Why do you think you’re bothering me? She’s like, “Well, I just get the impression you don’t want me here.” Did I tell you to leave? “No, but are we okay?” We’re fine! You’re fine. I have to make that connection. So if I don’t do that, people feel like there’s something profoundly lacking, and they feel uncomfortable. It’s very disquieting to them.

Does that friend know what your diagnosis is?

Yes, she knows, and she tries very hard. She makes adjustments for me, I make adjustments for her. That’s the sort of mutual investment in the friendship.

I think most people are so used to feeling like they have to be people pleasers, and that everyone else should be that for them, I can imagine why it would be unsettling to be around someone who, while they’re maybe not doing you any harm, they’re not going out of their way to practice those social pleasantries, either.

Exactly. And if I was completely mask off, and something tragic happened to them, if she was lost a parental figure and came to tell me about it, I would just look at her with a flat look of, “Okay.” It wouldn’t be “Are you okay? What can I do for you?” It would just be, “Alright.” And that’s not a good response to have when someone’s having a grieving process. You have to engage. I learned very early on that there are responses that are required for people to not be very uncomfortable.

Is that something that gets easier with time, or is it something you’re always working on?

No. It’s always, always, always a pain in the butt.

You’ve said you get a lot of death threats online when you post about your experiences as a psychopathic in forums. Why do you think some people respond that way to you? Do you have any idea?

I think it comes from a visceral fear of the unknown, or fear of evil. Hollywood has desperately pushed this narrative of psychopathy. And when you’re taking away the villain, which is really what psychopaths are in movies, people get very upset about it. I don’t know if you’ve seen sites like Love Fraud or Psychopath Free, on and on and on, but there are all these sites where people go when they’re convinced their ex is a psychopath, when really their ex was just a toxic, awful person. There are millions of those, and they’re everywhere, and they come from every neurotype.

Is there anything that you feel that I left out, that you would like to add?

It’s a lot more complex than people realize. I think it’s important to hold people responsible for their actions, not brain formation. People make choices. Psychopathy is not an excuse, and it’s definitely not a reason why someone does bad things. People do bad things because they make bad choices. So instead of looking at psychopathy as this constellation of things that represent evil, just look at it as a different way of experiencing the world, and what a person chooses to do with that is on that person.