Psychopathy vs. NPD

By Rhonda Freeman, Ph.D

Basic Differences Between Psychopathy & Narcissistic Personality Disorder

Many symptoms of psychopathy and narcissistic personality disorder overlap.

Miller, Dir, Gentile, Wilson, Pryor, & Campbell (2010), found a moderate positive correlation between the two conditions. Interestingly, many scientific studies uncovered similar findings.

Several experts in the field suspect that narcissistic personality disorder and psychopathy are conditions that lie along a continuum or spectrum.

I agree with this stance, because they take very similar approaches in their interactions with others.

Individuals with both conditions tend to be exploitive of even the people who love them, with minimal regard for the pain they cause.

Similar to psychopathy, narcissistic personality disorder is suspected to be more common among males. According to the Diagnostic and Statistical Manual of Mental Disorders 5th ed. (American Psychiatric Association, 2013) "Up to 75% are male."

Both groups tend to 'blame shift' and refuse to accept responsibility or be accountable for poor behavior.

Overview of the similarities and differences between psychopathy & narcissistic personality disorder

Similarities:

Arrogant

Superficial

Vindictive

Charming | Charismatic

Dominant

Selfish

Exploitive of others

Immoral (care-based)

Low in empathy

Insensitive

Antagonistic

Promiscuous

Manipulative

Differences:

Extremely sensitive to the opinion of others (Narcissistic personality)

Requires positive attention (Narcissistic personality)

Minimally burdened by anxiety or fear (Psychopathy)

Deceitful (Psychopathy)

Low Conscientiousness (Psychopathy)

Aggressive (Psychopathy)

Indifferent to the opinion of others (Psychopathy)

Fragile (Narcissistic personality)

Easily prone to boredom (Psychopathy)

Impulsive style (Psychopathy)

Extreme promiscuity (Psychopathy)

The differences in the list above is not always cut and dry.

Those who meet diagnostic criteria for narcissistic personality disorder can also demonstrate a pattern of deceitfulness or some of the other traits primarily demonstrated within psychopathy.

For example, an individual with narcissistic personality disorder can certainly demonstrate patterns of promiscuity when they are seeking the admiration needed to keep them functioning.

Therefore, the labels above are tagged to the traits that are most commonly found within that particular disorder and not necessarily only found within that condition.

Skilled clinicians (through thorough evaluations) will be able to tease out if the condition is present and which symptoms are true reflections of a particular disorder.

When clinicians are involved in the diagnostic process of determining the presence of a personality disorder it is not uncommon to find features and traits of more than one condition. Often human beings simply do not fit one. Blending of personality disorders is not an uncommon occurrence.

Let's go a bit more into the conditions

Psychopathy

Psychopathy is a disorder that impacts the way the brain processes emotional information. MRI studies of the brain have demonstrated that there are significant limitations in their ability to process certain emotional states.

Kiehl, Smith, Hare, Mendrek, Forster, Brink, Liddle (2001) examined a psychopath's ability to process words that should elicit a response from the brain's 'emotion processing regions'. They presented a group of criminal psychopaths as well as two groups of non-psychopaths with a word-list memory test that consisted of neutral and negative words.

A normal brain should respond to the negative words by processing them using both the thinking and emotion processing areas (e.g., paralimbic region). What they found was quite interesting. When the psychopaths were compared to the non-psychopath groups the results indicated that the group with psychopathy processed the negative words through the thinking (cognitive) regions only. There was minimal engagement from their emotional regions, which completely contrasts the workings of a normal brain.

The negative words did not elicit the emotional system to respond. Interestingly, psychopaths used their thinking regions 'more' when presented with negative (emotion eliciting) words, thereby demonstrating better recall of the negative words within the list. It suggests that the thinking areas of their brains work harder when they are presented with emotionally charged information.

Essentially, the psychopaths did not use the emotion processing regions of their brain as it should or like the non-psychopathic groups. Instead they relied upon their language processing (semantic) and decision making areas - the thinking regions.

It is possible that one could extrapolate and conclude that if a person cannot process emotional information properly, then many experiences or people that should hold deep meaning, simply do not.

For an individual with strong psychopathic traits, everything is replaceable, particularly if it has lost its usefulness, appeal, or 'newness'.

A "chair" or "wife" - feels the same. There is not a deep emotional bond with either - only a needed use.

Although emotional states such as genuine appreciation are low, individuals with psychopathy are prone to intense feelings of anger, low frustration tolerance, and boredom (Blair, 2010). They can easily shift into a disdainful and contemptuous state when they are no longer stimulated or interested in a partner.

This sudden change can come across or 'feel' cold and callous to the former object of their affection. Individuals with strong psychopathic traits can communicate something that should be emotional with very little emotional tone, as though there were no genuine feelings behind their words (because there really is not).

Due to their brain disorder, those with psychopathy rarely learn from their mistakes. They tend to repeat the same behaviors - particularly if the activity is

a) pleasure oriented,

b) has a significantly stimulating 'chase' period, and/or

c) has a high pay off.

Most tend to run an agenda that is in extreme opposition to the wellbeing, safety and harmony of others.

They are deceitful, remorseless, and often dangerous.

Psychopaths frequently engage in violating behaviors. It is not uncommon for those with strong traits to consistently infringe the rights of others, often in the most egregious ways.

There is a tendency to lie for purposes of bolstering their image, to get out of trouble, or at times for no apparent benefit or reason at all.

It is not uncommon for those with psychopathy to have a near complete inability to accept fault or responsibility for any pain or chaos created by their behavior.

They are manipulators, con artists, and see others for their use or purpose. Calculating how a particular person, group, thing, or scenario benefits them, even to the demise of others who caused them no harm, is often the norm for an individual with psychopathy.

Although individuals with narcissistic personality disorder are also exploitive - violating others, deceitfulness, and conning are more common amongst psychopaths.

Many with psychopathy enjoy attention, however their love of attention has very little to do with approval or admiration from the source.

NPD

Whereas, individuals with narcissistic personality disorder love attention as well (admiration), however they tend to need positive attention for validation.

Their feelings can be easily hurt (e.g., "injury") if others do not reflect back to them their specialness. For many with narcissistic personality disorder, this can lead to reactions of agitation, aggression, or punishment of the perceived offending party.

It is not uncommon for an individual with narcissistic personality disorder to be bothered by what others think of them and only want to be held in high regard. Hence, they use their audience to reflect back how special they are.

Conversely, an individual with psychopathy really does not care what others think of them - their self esteem is minimally tied to external relationships. However, many with this condition want to be held in high regard, but this tends to be tide to power or manipulation. Their feelings of superiority is not based on the opinion of others.

If there is an audience, they tend to abuse those individuals or manipulate and use them for personal gain or exploitation purposes, (e.g., for sex, reproduction, public perception of normalcy, child care, money, housekeeping, further their power, do their 'dirty work', a 'project' partner to corrupt or engage in perversions).

Narcissistic personality disorder is a condition related to garnering admiration, collecting an audience ('supply'), imposing their likes/beliefs on others, replacing old audiences with new ones, and draining the attention of others. They need positive attention. If not received, their mood status can become severely dysregulated.

While psychopathy is similar, it is a disorder that veers strongly in the direction of violating the rights of others, control, winning, conning, deception, and using others for their own advantage. The opinion or approval of other people are not a factor in their self esteem. They do not care. Others hold no genuine value to them.

In their study that examined psychopathy and narcissistic personality disorder, Fossati, Pincus, Borroni, Munteanu, & Maffei, (2014) found that although the conditions share many similarities, narcissistic personality disorder and psychopathy are "distinct" disorders. Their results supported the presence of heightened emotionality when comparing those with narcissistic personality disorder to psychopathy.

Variants of Narcissistic Personality Disorder & Psychopathy

Similar to psychopathy, narcissistic personality disorder is a condition that is suspected to demonstrate variants (subtypes).

Research consistently supports the presence of an emotionally dysregulated variant of psychopathy whereby anxiety and emotional lability is demonstrated (i.e., Secondary Psychopathy).

Narcissistic personality disorder is also suspected to have a similar emotional dysregulated type whereby the disordered individual demonstrates a quieter/ covert presentation, hypersensitivity, "vulnerability", a tendency toward anxiety, with lower levels of extroversion.

The two subtypes of narcissistic personality disorder are grandiose and vulnerable.

While the two subtypes of psychopathy are primary and secondary.

There are some individuals who can have traits of both variants with regard to psychopathy or narcissistic personality disorder.

It seems that the diagnostic criteria of narcissistic personality disorder has been equated with the grandiose variant only, when in fact there is more than one presentation of this personality disorder (i.e., vulnerable).

"Vulnerable narcissism reflects a defensive and fragile grandiosity in which the grandiosity serves as a façade that obscures feelings of inadequacy, incompetence, and negative affect."

Individuals who meet criteria for psychopathy, as well as those with narcissistic personality disorder tend to feel superior to others. Those with psychopathy perceive themselves above others; while those with narcissistic personality disorder also hold this belief, however they are able to identify with an elite few they feel are on par with them - or those they aspire to be associated with.