Abstract
Background: Psychopaths represent a large cost to society due to their high criminality, antisociality, the costs of incarceration and the notion of therapeutic nihilism that dominates the literature. Subtypes of psychopathy seem to exist that map onto Karpman’s constructs of primary and secondary psychopathy. Cultural differences exist in the phenotypic structure of psychopathy and so further research is needed to ascertain whether similar subtypes emerge among psychopaths in the United Kingdom and what implications this may have for effective treatment and risk reduction Method: Data was collected as part of standard assessment and follow up procedures at 4 Dangerous and Severe Personality Disorder Units over a 10 year period. Standardised psychometrics were used to assess for psychopathy, personality disorders and risk. Cluster analysis was employed to determine if subtypes of psychopathy emerged from the data and subsequent ANOVAs were used to externally validate and differentiate the emerging clusters. Finally, regression equations were used to determine whether cluster membership could predict change in risk over treatment. Results: Two subtypes of psychopathy emerge in the data resembling primary and secondary psychopathy. These subtypes differ in regard to symptomatology, personality profiles, exposure to childhood trauma, recidivism rates and risk. It was hypothesised that subtype membership would affect outcome. The best predictor of future risk is previous risk. Conclusion: Psychopathy should not be viewed as a unitary, nosological construct. Clear subtypes emerge in the data that can be differentiated by a range of variables. This has implications for more person centered treatment planning and potential future risk reduction.