Episode 114: How To Identify A Female Psychopath
Jason Smith, PsyD, ABPP, Ted B. Cunliffe, PhD, David Puder, MD
There are no conflicts of interest for this episode.
On this week’s podcast, I interview Jason Smith, Psy.D., A.B.P.P., Chief Psychologist at a prison in the United States, and Ted B. Cunliffe, Ph.D., who is a clinical and forensic psychologist at a private practice in Florida. Together, along with Carl B. Gacono, Ph.D., ABAP, they have written the book Understanding Female Offenders, researching how female offenders’ psychopathic behaviors present differently than in males and how we can address biases we may have in order to identify, assess, and treat these women.
“Dealing with incarcerated women and specifically psychopathic women can be challenging. Understanding Female Offenders: Psychopathy, Criminal Behavior, Assessment, and Treatment, provides readers with a better conceptualization of the psychopathic/non-psychopathic female. This includes better ways of interviewing, assessing, and treating these women, and clinical caveats with case examples to assist with clinical applications. This is the only comprehensive resource that provides specific knowledge about female offenders, particularly on female psychopathy and assessment.”
Caleb Carr describes a fictional account of a female psychopath in his book Angel of Darkness:
“None of those personalities, those different ways that people see her are complete. None of them is a description of an actual person– they’re all simplifications, exaggerations. Symbols, reality. The ministering angel-- the fiendish killer. The devoted wife and mother-- the wanton harlot and brazen hussy. They all sound like characters out of a story or a play” (p. 437).
Why Have We Seen A Rise In Females Within the Jail System?
“According to the Sentencing Project, between 1980 and 2017, the number of incarcerated women increased by more than 750%, rising from a total of 26,378 in 1980 to 225,060 in 2017 and the number continues to rise.”
Dr. Smith and Dr. Cunliffe believe there are a couple of reasons we have seen this rise. One is that we have simply become more aware of the fact that females can commit crimes, so we have become more focused on the crimes of women. Statistically, the number of incarcerated females still pales in comparison to the percentage of incarcerated males, but the rise is certainly undeniable.
Historically, women have been infantilized; it was once impossible to think women could commit crimes. There is still a lot of bias surrounding women and their ability to commit crimes. Even if they did commit crimes, they are often not seen as being able to be held accountable for those crimes. As more women have been held accountable, we have seen a decrease in this bias.
For example, in recent years incidents that have had a lot of media coverage, such as stories of teachers committing sexual offenses towards students, have played a role in breaking down some of that bias and made it more understandable that women can commit crimes.
From the 80s on, we also saw a rise in legislation and policies that increased the offenses for which people could, in general, be incarcerated. Consequently, we saw a rise in the amount of males in the prison system, as well.
Substance abuse crimes are also very prevalent among women, so as the legislation has increased surrounding this, it has also driven up the percentage of incarcerated female offenders.
Why Do We See The Rate of Mental Health Issues in the Female Inmate Population That We Do?
All around, there has been a cultural shift towards deinstitutionalization. There are far fewer community-based psychiatric units than there used to be (down 70-80% in some areas from 30 years ago). As many of these facilities close, there are simply less places to put people who are unstable. Jails, unfortunately, tend to fill this role.
Currently, 44 states have more mentally ill patients in their prisons and jails than in the state hospitals; state hospitals simply can’t house them for long periods of time. Even in the event they are admitted to a mental health facility, it is hard to receive insurance approval beyond five days, far less time than many of these patients need.
Consequently, these patients go on to commit crimes and end up in the prison system.
What are the Differences Between ASPD and Psychopathy?
Psychopathy is an old construct that tends to have some confusion surrounding it. When we talk about psychopathy, we are referring more to the personality aspects of an individual, such as affective disorders and other interpersonal aspects.
Antisocial personality disorder describes criminal behavior; it does not access personality variables. However, not all antisocials get caught. They may be more adept at hiding their crimes.
Sociopathy is closely related to ASPD, concerning behaviors more than personality. It is also often a precursor to ASPD.
Male Psychopathy vs. Female Psychopathy Presentation
We have learned through the years that male psychopathy and female psychopathy present differently. We used to diagnose women based on the same criteria as men, but learned that their behaviors were actually different.
The hallmark of a male psychopath is narcissism. Male psychopaths tend to be pathologically self-focused and grandiose. They lack empathy and do not interact with others as equals. This is elite narcissism.
There is another type of narcissism called malignant or antisocial narcissism. Malignant narcissists do antisocial acts, combined with narcissism, and have violent tendencies and enjoy violating the rights of others.
Women do not present with narcissism often. What you tend to see is more histrionic and borderline personality disorders combined with ASPD. They do want to experience belonging in their interactions with others, but still display a lack of empathy at times because they find it difficult to label emotions. They may also present with dramatic mood swings and use manipulation to receive the attention they need. On the more extreme end of this spectrum, there are elements of self-harm and suicidal tendencies.
We often think of it this way: all psychopaths are antisocials, but not all antisocials are psychopaths. Even so, not all psychopaths break the law; there are successful psychopaths. And not all antisocials break the law either.
What Levels of ASPD do we See in Jail?
Considering the rate of those with ASPD that end up committing crimes and going to prison, about 20-25% of those in prison meet the criteria for psychopathic personality disorder. We define this as a PCLR score of 30 or higher. Most people in prison meet the criteria for ASPD; it is very common. So many people in prison have ASPD, but about 20-25% of these have psychopathic personality. The number may be about 15-20% for female psychopathic offenders.
How Can We Avoid Diagnostic Biases?
When we are diagnosing and assessing patients, we have to consider bias and logical fallacies.
Table 2.1, pictured, shows some common logical fallacies and thinking errors.
A common bias is confirmation bias, where there is a theory going in and instead of considering both data that does and does not support our theory, we only take into account the data that supports our theory. This affects diagnoses, assessment and treatment.
An example of this is using the male diagnoses standard of psychopathy to diagnose female psychopaths. They do not present in the same way and we can miss the other signs, such as coyness, seductiveness and being self-focused, if we use the same scale.
At one point while working in a federal female prison in California, Dr. Cunliffe describes his experiences seeing women always getting into trouble and showing no remorse. He said they would be presenting psychopathic behaviors, but not with the same type of callousness seen in men; he described it as a “friendly” callousness. Instead of displaying the commonly associated narcissism trait, they would portray themselves as victims, usually to engender sympathy.
Females Psychopaths Care About Their Perception
There is also the commonality of these women to seek the approval of other women. Dr. Cunliffe shares another story from when he used to conduct interviews with a female co-researcher. She would sit in the back and observe the interview, and he would be fascinated by the fact that the women he was interviewing would look at her; they were very concerned with what she thought about them. They wanted her approval and would make excuses for their behavior in attempts to receive it.
So we see that female psychopaths are very sensitive to how other women perceive them, unlike male psychopaths, who are characterized by the excessive bragging and grandiosity and do not care about their perception.
These are key aspects of female psychopathy and so we must take a very different approach with diagnosing and treating women.
What is the Psychopathy Checklist?
Bob Hare created the psychopathy checklist (PCL-R) in the 1980s. Before that, there was no real psychopathic standard of measure. What is significant about his checklist is that it is not structured as a self-report by a patient; it is an interview.
This checklist has proven to be very reliable and valid, with an inter-rater reliability of .98. It has been revised over the years as research continues to develop. PCL-R is the only measure that shows valid ways of comparing psychopaths and non psychopaths.
The File Review
A crucial step before conducting the PCL-R interview is conducting a file review. We must know their history so we can corroborate their stories to see if what they say is true. For accuracy, we need to know if their answers match their files or if they are lying to us.
We can also use the file review to challenge them. For example, at the end of the interview (because it is often upsetting to them and could derail the interview if done early on), you could pretend to be upset with them, as though they have lied to you, and see how they respond. It is one thing to ask a patient if they have issues with anger and another to try and recreate the anger in the interview. This can often produce a reaction that will confirm something in their file that they may not verbally admit to you.
Psychopathy checklist
These are a few components of the PCL-R and ways they present differently in male and female offenders.
Glibness/Superficial Charm
In Females
Enticement of examiners (of both genders) to protect and rescue her. Her strategy is to incorporate the examiner into her struggles and have them rescue her from her emotions, aid in regulating her self-esteem, and mirror back to her that she is a good person.
Devaluation and aggression
When those strategies fail to engage the examiner, the underlying malevolence may surface in the form of aggression, such as threats and devaluation.
Devaluation is subtle and usually starts right away. Psychopaths are very skilled in this area.
Dr. Cunliffe gave an example of when he encountered this type of aggression during an interview with an infamous psychopath in their prison system. At the end of the interview, he challenged her by saying he was upset that she had been lying to him. In her mind, this was the first time he was seeing her for who she truly was. She became very upset and said that he’d better give her a good evaluation or he would “rue the day” he crossed her.
Devaluation is huge. It is used as a manipulation tool for division. Once, in another interview, a female psychopath zeroed in on Dr. Cunliffe’s shoes (he loves shoes). She observed what he found fascinating and used it to devalue others who didn’t have nice shoes, or have the same great taste.
3. Sexualized verbal and nonverbal behavior
Not overt, but subtle (winking, salacious eye contact, touching, body posture, using appearance to charm)
Becoming sexually involved with the staff and then using that to get money, drugs, and preferential treatment.
Dr. Smith was conducting research in a correctional setting and getting ready to interview a female inmate. The inmate didn’t realize she was meeting with a male researcher and when she found out, in the hallway, she quickly improved her appearance by putting her hair up in a bun. The next time they met, she knew she would be meeting with him and she was ready with her makeup and earring to play up the superficial charm.
As a note, we work at preparing psychologists with strategies to protect themselves from being sexualized. We do this a few different ways:
Making them aware that this is the environment they will be walking into
Helping them establish boundaries
Teaching them that it is essential to consult with colleagues and to work collaboratively; a psychopath wants to promote division and this will prevent that
Bringing awareness to countertransference, such as feeling violated or feeling flattered by the sexual advances and comments
In Males
Self-assured and boastful
Slick/smooth presentation intended to impress and cajole others
Overt
Often that “used car salesman” persona, working the room
Grandiose Sense of Self-Worth
The word “grandiose” doesn’t capture this characteristic as much to a woman, but it's still the word used right now in this item.
In Females
Subtle glances or seductive body movements
Preoccupation with others’ perceptions of them
Tendency towards self-dramatization, impressionistic speech
More passive and indirect; not overt
Become defensive and hostile when their image (as fabricated by stories, direct lying, emotional outbursts) is challenged.
Sherlock Holmes famously said, “Unwanted truths are not popular.”
A pathological self-focus on maintaining an image
They like looking at themselves in the mirror
The women don’t like what they see, as opposed to men who love looking and what they see. This is a key difference between the two.
It drives much of a female’s thinking and behaviors. Chronic self-criticism, how they are being portrayed. They are consumed by it.
Males are not consumed by this; they don’t care.
Maintaining a victim stance to circumvent responsibility
An underlying damaged self
Where a male psychopath will easily list all of his wonderful traits, a female is less likely to do this (unless it is superficial, such as her hair).
Dr. Smith shared a funny example of what he named one of the highest-rated PCL-R patients he had ever seen (she would have been a 40, but they didn’t have enough evidence, so she was rated at 38.9.) When talking about STDs she said, “My blood is cleaner than Jesus.” This clear sense of grandiosity is summed up well in this statement!
In Males
Bravado (not aware they are not flattering)
Dominance; they may take control of the interview
Contempt for others
Self-assured, opinionated, cocky
Lack of insight
This comes out in their narcissism. They are able to go on and on about their talents, but if you ask them to describe their shortcomings, they will be stumped. This can be the case even in women who are sentenced to life in prison!
I occasionally treat someone who has a flair of grandiosity. It is hard for psychopaths to seek out treatment; however, they often seek treatment for another reason, such as asking for help dealing with a person in their life, for help getting disability, or in the hopes of being prescribed mind-altering drugs like benzos.
Cunning/Manipulative
“The use of deceit and deception to cheat, bilk, defraud, or manipulate others… use of schemes and scams motivated by a desire for personal gain…carried off in a cool, self-assured, and brazen manner.”
In Females
Not overt, very subtle.
All of their manipulation is very subtle
Again, very concerned about how they are perceived
Much less likely to tell you about the things they’ve done/brag (good or bad), and usually they have an excuse for their behavior. You have to look at their data and files, not just what they tell you.
Interview style has to come across as supportive and nonjudgemental.
2. Pseudo dependency
They are looking for interaction with another to build up their sagging self-esteem/sense-of-self. This is where BPD comes into play; they feel empty. They want someone to fill the void through interaction and support.
3. Pseudo emotionality
Mirroring: superficial concern for others in an interest of secondary gain
They can’t regulate their own emotions, they want you to cheerlead for them, mirror back that they are doing ok or are a good person. They want to get propped up because of their damaged sense-of-self. They want you to regulate their emotions.
They present a shallow affect, like they have deep emotions, but it is short-lived and not deeply felt.
Sex/appearance used as manipulation tactics
Involved in drug deals where they may be selling less than agreed, burning clients
Quotes from patient interviews:
I am exceptionally emotionally intelligent. How I manipulate emotionally, I get like a virus and infect them (same person who compared her blood to Jesus’).
She knew how to use emotions; she knew what other people were looking for and how she was supposed to react in order to manipulate their behaviors.
This is how psychopaths manipulate, in general. They can assess someone very quickly and very accurately and then give them what they think they need as a means to manipulate. (“You are looking good today.”)
I wasn’t taken advantage of, I need certain things… all women do that, use sex.
(I) hustled pimps out of money.
I turned people into addicts. I am a master manipulator, I make shit happen. I can get the shirt off your back, doc. I am a money maker in the street, I talk a good game.
Once you start interviewing, with time, the measures we give do break down their defenses and they open up eventually (as evidenced by above quotes).
Lack of Remorse & Callous/Lack of Empathy
Lack of Remorse: to experience a general lack of concern for the negative consequences that his actions, both criminal and noncriminal, have on others.
Callous/Lack of Empathy: attitudes and behaviors [that] indicate a profound lack of empathy and callous disregard for the feelings, rights, and welfare of others… he is cynical and selfish.
In Females:
Desires mirroring of an image she attempts to maintain
Appearance: a good mother. Reality: little interest in her children, or their activities, and no attempts to maintain contact with them
Wanting to have a “good mother” image but just mirroring what they think they are supposed to be
Very hard for them to admit they are capable of doing things that are not good (facing their shadow self)
They know the definition of what they should say but it’s superficial (such as describing shame) and they can’t go deeper or expand on it.
Present that they have done bad things, but lack in-depth emotional knowledge.
Callousness is presented verbally, through passive aggressiveness, lack of empathy, gossip
Female psychopaths have more need for attachments than male psychopaths
They need people to give them attention.
Women are much more likely to offend people they know, but men are more likely to offend strangers, because males have more detachment
Rorschach data: texture responses
Males have low scores and females have high scores (low=low attachment; high=high attachment)
91% of male psychopaths had no textures responses, indicating no ability to form attachments to people
Some females had no texture responses (about 50%), but 30% of females had more than 2, even 7-8, indicating an extreme need for attachment
Interpersonal dependency- they need others for interactions; severe attachments/neediness and maladaptive neediness
In Males:
Violent behaviors towards property and others that suggests “overkill”
Assaulting a robbery victim when not necessary
Continuing to punch/kick someone when they are unable to defend themselves
Mistreatment of animals
Pleasure gained in violent activities
Are loners by choice and cannot form attachments (evidenced by the low Rorschach scores)
Males’ callousness is overt (trashing houses for fun and items stated above)
The low Rorschach scores are a big difference between males and females
Shallow Affect
Unable to experience a wide range and depth of emotion... and emotions may be dramatic, shallow, and short-lived. (pseudoemotionality)
In Females:
No depth and quickly passing emotions
Unable to describe emotional subtleties despite their display of pseudoemotionality; superficial understanding of emotions
Tears may be present, but it may be a manipulation tactic for projection from the interviewer.
Narcissistic Mirroring
“I did that,” says my memory. “I did not,” says my pride: and memory yields.” –F. Nietzsche, Beyond Good and Evil
Our minds play tricks on us to protect the image that we want to believe about ourselves.
Seeing their children as extensions of themselves and not their own entity
3. Look at the meaning words such as “close, guilt, and remorse” have to them
They can give a dictionary definition of emotions like this, (although they confuse remorse and guilt often), but they have trouble explaining what they feel bad for (not really feeling something, shallow affect).
4. Look at attachments
Is there depth to their statements of attachments? Do they actually call, write? Do they ask about others?
Parasitic Lifestyle
Many cultural aspects involved
Need to assess total culture
Staying at home as a mom, but receiving money from family or social assistance and spending on drugs, not taking care of the children.
How is money spent
Disability benefits revoked
Males may not pay child support
Promiscuous Sexual Behavior
Sexual relations with others that are impersonal, casual, or trivial… indiscriminate sex partners.
Males endorse their promiscuity with pride, and will easily tell you the number of sexual partners they have had.
Both male and females describe sexual activity or deviant behavior with a sense of discomfort or reticence
Males have less discomfort than women
A female was asked how many sexual partners she had and she gave a low number. The interviewer challenged her at the end, confronting the fact that she had been charged with prostitution.
It must be considered that sometimes this is because there is trafficking, abuse.
Early Behavioral Problems
Serious behavioral problems as a child: persistent lying, cheating, theft, robbery, fire-setting, disruption of classroom activities, violence, bullying, running away from home.
Less overt in females than males
Less fire-starting, for example, and more gossiping, ostracizing
May not be behaviors that will show up in the records as easily.
Diffusion of responsibility; rationalization of behaviors
“My parents were the reason I acted out.”
“It was not my fault, nobody ever took the time to talk to me about anything.”
“My parents and adults were always getting in my way so I said and did those things to get what I wanted.”
Before age 9:
history of assaulting teachers, making false sexual allegations against teachers and camp counselors, stealing, lying
Final Thoughts
The biggest takeaway is understanding that female offenders and female psychopaths present differently than males. If you interact or treat this population, shifting your conceptualization, recognizing the differences, is paramount. The book goes into great depth to explain this.
Additionally, the element of bias. There is a great deal of bias towards this population. There are volumes of materials talking about the female psychopaths as victims, while this book contains much data to support the fact that they have been less severely treated than men. Women are more likely to receive services, while males are more likely to be incarcerated. Go by the data, not the cultural bias.
We will maybe do a part two of this if there is enough interest. I really enjoyed gaining some knowledge of female psychopathy so I can have a better understanding of how their minds work, so I am less likely to fall prey to their manipulation tactics.
Although I have no financial link to this book, the publisher was nice enough to offer a discount for my audience: