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‘Almost psychopaths’ are out for themselves

Copyright 2002 President Fellows Harvard College behalf HMS MediServices Phoby LizGreen HMS MediServices Anthony Leader Komaroff MD Harvard Health Publications

Copyright 2002 President and Fellows of Harvard College on behalf of HMS Media Services, Photo by Liza Green, HMS Media Services, Anthony Leader Komaroff, MD, Harvard Health Publications

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Updated: November 18, 2012 6:22AM

Dear Doctor K: I hear people talk about psychopaths. Can you tell me how to recognize them? Do they “snap” and become violent?

Dear Reader: Psychopathy is a psychological condition. I’m sure that events and relationships earlier in life have some influence on whether a psychopath behaves in a destructive way. But I also think the evidence shows that psychopaths are “born” more than they are “made.” It is my opinion that the condition is inherited, and that it produces changes in brain chemistry that lead to psychopathic behavior.

Psychopaths are extremely egocentric, engaging in immoral and antisocial behavior for short-term gains. They are predators, and anyone who they think can feed their need is potential prey.

Psychopaths engage in planned, controlled and purposeful aggression. The primary goal is not necessarily to injure others, but simply to get what they want. They are also more likely to engage in impulsive behavior, to become emotional and aggressive.

Psychopaths are often superficially charming and glib. At first, they capture people’s attention easily and even gain their trust. That helps them to take advantage of others.

Some, but not all, psychopaths can be violent. But a psychopath is just as willing to use a well-timed compliment to achieve his or her goals.

Fortunately, there are relatively few true psychopaths whom we interact with. But unfortunately, there are a lot of people with some of the same personality features. There’s a newly emerging term, an “almost psychopath,” coined by researchers at Harvard Medical School. The distinction between a psychopath and an “almost psychopath” is the lesser degree and frequency with which they exhibit psychopathic traits.

Perhaps you suspect you are involved with a psychopath or “almost psychopath.” Here are some considerations and actions to keep in mind:

Accept the possibility that you are in a very bad situation, perhaps with someone to whom you are closely attached.

Document, privately and carefully, the behaviors and events that concern you.

Reach out to others for help.

Trust your gut instincts.

Say something. The silence of those that psychopaths and “almost psychopaths” betray, manipulate and abuse is perhaps the greatest ally they possess.

If you find yourself being hurt or otherwise abused, get out as quickly and safely as you can.

I’ve put a description of an “almost psychopath” on my website: It’s taken from an insightful book by my Harvard colleagues Dr. Ronald Schouten and Dr. James Silver, “Almost a Psychopath.” In everyday language, it describes how to recognize “almost psychopaths” and how to protect yourself from them. An ounce of prevention is worth a pound of cure.

Write to Dr. Komaroff at

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