Despite the fact that only 1 percent of the overall population qualifies as psychopaths, they surround us. It could be your neighbor, co-worker or even a relative. The majority of psychopaths are walking among us, immersed in careers that nurture their psychopathic traits, and in some cases even reward them.

But how do forensic psychiatrists diagnose psychopaths?

That’s what the Hare Psychopathy Checklist-Revised was created for – a diagnostic tool, used to rate person’s antisocial or psychopathic tendencies for clinical, legal or research purposes. The checklist is used to diagnose adult males in prisons, psychiatric hospitals and other correctional and detention facilities.

A 20-item symptom rating scale allows qualified examiners to compare a subject’s degree of psychopathy with a prototypical image of psychopathic personality, who is often described as an egocentric pathological liar, with a huge lack of conscience or sense of guilt, who ruthlessly prey on others using charm, deceit, violence or other methods that allow them to get what they want. Signs of a psychopath also include shallow emotions, lack of empathy, psychopath repeats violations of social norms, disregard the law and often has a history of victimizing others.

Experts in the field agree that the checklist is the best method for determining the presence of psychopathy in a person. Recent experience suggests that it can be also used to diagnose sex offenders as well as female and adolescent offenders.

The Hare Psychopathy Checklist-Revised is now often used in the courtroom and in institutions as an indicator of the potential risk posed by subject and prisoners. The results of the examination are also used in forensic settings. It helps to decide the length and type of prison sentences and the possible treatment if needed.

Diagnosing someone as a psychopath is a very serious and dangerous step. That’s why it has to be done by professionals who have been specifically trained in its use and who have familiarity with studies of psychopathy. Professionals who administer the examination should have advanced degrees, such as M.D., Ph.D., or D.Ed. in a medical, behavioral or social science field. Other recommendations include experience working with criminals or some other related training. Because the results are often used in legal cases, administers should be qualified to serve as expert witnesses in the courtroom. It’s also recommended, if possible, for two experts to test a subject independently with the Hare Psychopathy Checklist-Revised. The final rating is determined by averaging their scores.

The checklist contains two parts – a semi-structured interview and a review of the subject’s records and history. The clinicial scores 20 items that measure central elements and signs of the psychopathic character:

  • glib and superficial charm
  • grandiose (exaggeratedly high) estimation of self
  • the need for stimulation
  • pathological lying
  • cunning and manipulativeness
  • lack of remorse or guilt
  • shallow affect (superficial emotional responsiveness)
  • callousness and lack of empathy
  • parasitic lifestyle
  • poor behavioral controls
  • sexual promiscuity
  • early behavior problems
  • lack of realistic long-term goals
  • impulsivity
  • irresponsibility
  • failure to accept responsibility for own actions
  • many short-term marital relationships
  • juvenile delinquency
  • revocation of conditional release
  • criminal versatility

These 20 items cover the nature of subject’s interpersonal relationships, his affective or emotional involvement, responses to other people and situations, evidence of social deviance and lifestyle. They also cover two key aspects that help define the psychopath: selfish and unfeeling victimization of other people, and an unstable and antisocial lifestyle.

The interview covers subject’s background, including work and educational history, marital and family status and criminal background. Since psychopaths are often a pathological liars, the information must be confirmed by reviewing the documents in the subject’s case history.

When the examination is properly completed, the checklist provides a total score that indicates how closely the subject matches a classic or prototypical psychopath. Each of the twenty items is given a score of 0, 1, or 2.

A typical psychopath would receive a maximum of 40, while people with no psychopathic traits would receive a score of zero.

A score of 30 is enough for a person to qualify as a psychopath.

Many non-psychopathic criminal offenders score around 22, while people with no criminal background normally score only around 5.