07/11/2011 20:14 GMT | Updated 07/01/2012 05:12 GMT

What are Psychopaths Like in Real Life?

Being a psychopath is not just about anger. It's about all these other traits that Hollywood may not have the inclination to research or portray. Maybe that's because they are not really that glamorous.

I'd Like to Talk About Kevin

I've just seen that film, We Need to Talk About Kevin. Wow!

I really enjoyed it. The acting was outstanding and I was especially impressed with how effortlessly sinister and chillingly-vile the small child was. Even if I was the biggest bully at his school, I think I'd still give him my lunch money.

Like many films, this one succeeded in depicting violence, and a spine-tingling coldness. But in real life, true psychopaths have many other character traits. In forensic psychiatry, it is our business to diagnose and treat psychopathy as well as a range of other personality disorders and mental illnesses.

The term "psychopath" or rather "psychopathic disorder" was in fact originally a legal term, not a medical or psychiatric term. It was described in the Mental Health Act, originally in 1959, as: "A persistent disorder or disability of the mind that results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned." Sounds a bit more official than "creepy teenager who'd shoved his sister's hamster down a garbage disposal unit to upset his mom" - doesn't it? (Apologies if you haven't seen the film).

Character Traits of Your Typical Psychopath

Films can easily depict savage cruelty and a lust for violence, but as well as this, a true psychopath has a unique way of relating to other people, feeling emotions, and also makes well-recognised lifestyle choices. I have had the questionable honour of treating many psychopaths within in-patient medium security psychiatric wards during my career.

The aim is to try to decrease their risk in the future, in order to push them towards discharge, and integrate them back into the community they once wrecked havoc upon. One particular patient, Mr E, has embedded himself into my memory, as he was a textbook case - ticking almost all the boxes in terms of how a psychopath is defined.

Unlike Kevin in the film, life wasn't easy for Mr E. He was physically abused and severely emotionally bullied by his father - he actually thought his first name was 'Bastard' until the age of four. Yet he did fairly well at school, gaining five GCSE's, until he was pushed off the rails by alcohol and drugs. He often got into trouble at school for fighting, and with the police for dealing drugs. Psychopaths have turbulent upbringings and early behavioural problems with juvenile delinquency.

His index offence that landed him in prison, before he was diverted to a hospital, was a brutal assault on an elderly pensioner, who disturbed him as he burgled her house. Even though he appeared to superficially show remorse for this malicious crime, when I really challenged him, he did not accept responsibility, blaming his behaviour on intoxication.

This, as well as a lack of guilt and empathy, are typical traits of a psychopath. Inevitably, on the psychiatric ward that he resided on there were frequent arguments and occasional fights between the other patients, many of whom had a long history of violent crimes and personality disorders. Mr E seemed to take a perverse pleasure in stirring trouble, and would often chuckle to himself when he saw others fight.

Psychopaths are cunning, manipulative, and often convincing liars. Mr E exhibited these traits to escape arrest for several crimes in the past - a typical psychopath is criminally versatile, and Mr E had his proverbial fingers in many illegal pies, working as a pimp and a conman for several years.

He would bully less intelligent, vulnerable patients to sneak drugs on to the ward, and procure them with threats of disclosure rather than money. Psychopaths are typically parasitic, and Mr E demonstrated this by borrowing money from the less popular, marginalised patients on the ward by pretending to be their friends - but a psychopath cannot feel true warmth towards another human. They don't regard people as friends - only as opportunities. Any supposed loyalty is feigned. This, combined with sexual promiscuity, often leads to frequent infidelity and repeated, but loveless relationships. They also tend to feel permanently bored and empty, and any pleasure they experience is fleeting.

Mr E showed impulsivity, and an inability to control his behaviour, which manifested itself not only in the past by him breaching his parole conditions by using drugs, but also once when he attended hospital for an emergency whilst he was a prisoner, and ran away.

What are Psychopaths Actually Like?

Glad you asked!

Although their lack of empathy and their propensity for violence make psychopaths dangerous people, as previously mentioned, they are cunning and manipulative. Psychopaths I have treated in the past may have been indifferent to me as a person, but as their treating psychiatrist, it was in their interests to make me like them. This characteristic, combined with the grandiosity that comes across as confidence, usually makes them quite charming.

Mr E had a powerful presence, and easily slotted in at the top of the ward hierarchy. He was complimentary, friendly and flirtatious with staff, and could easily give you the impression, that although he looked down on most people, he valued your opinion. The weird thing was; even though I knew this, I couldn't help but be drawn into his personality.

The Hare Psychopathy Checklist

A Canadian Criminal Psychologist named Robert Hare created a list of 20 elements that define psychopathy, many of which I've talked about here. This checklist is the gold standard for diagnosis, though its interpretation should only be undertaken by professionals with experience in this field.

"With great power comes great responsibility", as Spiderman once said.

Being a psychopath is not just about anger. It's about all these other traits that Hollywood may not have the inclination to research or portray. Maybe that's because they are not really that glamorous. So for now, it can just carry on its representation of (admittedly very well acted) disturbed teenagers slaughtering innocent hamsters.