Reserve the word psychopathy for a true, innate lack of remorse, guilt and concern for others, which needs to be managed very differently from people who can feel guilt. It is not the same as antisocial personality disorder, most psychopaths are impulsive and low functioning, and ordinary ambition or grandiosity is not psychopathy.
What it is
Reserve the term psychopathy for people with a true innate impairment, not just a psychological problem, in feeling remorse, guilt and concern for others.
“I'm saying that we should reserve the term psychopathy for people who have a true innate impairment, not just a psychological problem when it comes to feeling remorse, guilt and concern for others”
28:24What Psychiatrists Get Wrong About Personality DisordersOct 2024 It is not a totally separate thing. It often sits on a narcissistic structure plus superego deficits: absolutely no guilt, and on top of that a desire to get over on people, to manipulate and use them.
“Psychopathy is not a totally separate thing. Psychopathy often has this structure and then often what we call like super ego deficits. So there's absolutely no guilt. There's often on top of this a desire to kind of get over on other people, to manipulate, to use other people”
52:49The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026 Psychopaths have the opposite profile to autism: strong cognitive empathy and bad affective empathy.
“If you look at psychopaths, they actually have the opposite profile to autism spectrum disorder. They have really good cognitive empathy. They're strong in cognitive empathy, unlike autism spectrum disorder. They have bad affective empathy. And I think there's actually research to show that autistic individuals actually have some internal affective reaction to other people”
50:14Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026 Even a true psychopath can look affectionate. It is not coming from a moral core that has weighed other people's reactions, but from what is easy, doable and pleasurable in the moment.
“It's not because he has some kind of a strong moral core where he has deliberated and felt about other people's reactions. It's because it seems to be easy and doable and pleasurable in the moment that he does it”
The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026
How we diagnose it
Antisocial personality disorder is not psychopathy. The diagnosis purposely covers low-grade rule breaking and a parasitic lifestyle as well as actual psychopaths.
“The antisocial personality disorder diagnosis is not psychopathy. It's purposefully encompassing both low grade tendency to break rules, basically. And the parasitic lifestyle and the actual psychopaths, right”
The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026 The Hare Psychopathy Checklist can be broken into two factors, and further into four.
“looking at the hair psychopathy checklist, you can break it up into two different factors. And then actually you can break it up into like four different factors”
The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026
What it gets confused with
Grandiosity, pride, ambition and a willingness to do what it takes to be the best are not necessarily pathological, and not necessarily the result of pathological narcissism or psychopathy.
“What are the ordinary aspects here? Well, grandiosity, pride, ambition, and a willingness to do what it takes to be the best, right? These are not necessarily pathological and these are not necessarily the result of pathological narcissism and psychopathy”
40:48The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026 The classic psychopaths people picture, the Ted Bundys, have something on top: sadism and high self-esteem.
“the classical people you think of as psychopaths, Ted Bundys, all that, they have what you just described with something on top of it, which is sadism and high self-esteem”
25:58What Psychiatrists Get Wrong About Personality DisordersOct 2024 There are high-functioning psychopaths, but most are low functioning: very impulsive, and probably incarcerated.
“There are high functioning psychopaths and then there actually are mostly low functioning psychopaths. Most psychopaths are low functioning. They're probably incarcerated. They're very impulsive”
50:39The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026
Pitfalls
Do not assume everyone who chronically harms others or violates their rights got that way from some awful experience. Many innately lack guilt and remorse, and they have to be managed very differently.
“a lot of these people who chronically harm others or violate their rights, I think they are lacking innately in that sense of guilt and remorse. And then you have to manage people like that very differently”
27:51What Psychiatrists Get Wrong About Personality DisordersOct 2024 Being far outside the norm is not enough to call someone mentally ill. A psychiatrist has to say in what particular way they are outside the norm.
“being outside of the norm is not enough to say if someone is mentally ill for a professional, for a psychiatrist. We need to say in what particular way is he outside of the norm”
11:40Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026
It also comes up on
From these episodes
- The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026 · 3 points
- Autism Diagnosis Explained: DSM-5 Criteria, Autistic Traits & the Difficult DifferentialSep 2026 · 1 point
- Lindsay Clancy Trial: A Forensic Psychiatrist Explains Psychosis, Malingering, & the Insanity DefenseSep 2026 · 1 point
- The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026 · 3 points
- What Psychiatrists Get Wrong About Personality DisordersOct 2024 · 3 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.