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Disordered selfhood may be a core phenotypic trait of schizophrenia spectrum disorders. This article is written from a European 

 In Anglophone psychiatry, phenomenology refers to a simple layman description of signs and symptoms, the latter preferably in their behavioral aspects. The symptom is viewed as a well-defined, quasi-objective entity liable to unproblematic quantification. For example, using the 

 presupposes the conception of a symptom as a pre-existing ripe fruit only waiting for a push from a pre-formed question in order to come into full view.

The term phenomenology used here is different from American usage. It refers to a faithful exploration, description, and conceptualization of the patient’s contents and structures of subjective life and modes of existence (eg, not only the content of the delusion but its mode of emergence and articulation and ways of experiencing the delusion).

Such an approach should minimally include:

Interviewing the patient in a way that maximizes their spontaneous self-descriptions, which can provide concrete and manifold examples of their abnormal experiences. This requires a non-judgmental attitude that prevents the clinician from prematurely reifying and classifying the patient’s inner life.

Such an interview, however, also requires that the clinician is knowledgeable, possessing a rich conceptual repertoire. An old dictum says, “perception without concept is blind.” In other words, if you are not well-read or trained, you will not be able to hear what the patient is trying to convey to you.

The rediscovery mentioned in the title concerns a profound dis-order of subjective life in schizophrenia. Distortions of subjective life for the patient is often their usual mode of existing in the world, and they only become accessible for the interviewer when they successfully facilitate the patient’s self-reflection and verbalization. The following patient perspective provides a clear idea what is at stake:

This dissolved self . . . It is a truly dissolved self. I feel that I am everywhere and nowhere at the same time. It is like a dream in which I am not present. It is like a sea where you can see fishes and plants and there is a current of water. It is in such a way that I feel that I am present. Not as a fish or a plant but as a current of water. My life feels like a manuscript written by someone else. I am open to the idea that my childhood was not my own. That my childhood is somebody else’s and that I have taken it over in some way. If you said to me that what I am telling you actually is about my friend instead of me, then I would be open to this suggestion. That my ideas stem from a movie or from another person.

This very metaphorical and evocative narrative conveys that the patient seems to lack a stable and substantial sense of self as an anchor and a vantage point. Normally our sense of self permeates our thinking, perceiving, and feeling. This patient experiences a disconnection from her thinking, speaking, and remembering, involving a global alienation toward herself. Although such rich descriptions are not very frequent, most of the patients are able to verbalize similar experiences in a more restricted vocabulary.

 between the narrative self (personality) and the minimal or basic self.

 If you ask a random individual on the street “who are you?” the person may respond “I am Paul Brown, 30 years old, working as an engineer.” He may proceed with information about his life history, his characterological traits, 

, preferences and goals, and the like. This level of selfhood we usually call personal identity or, in technical terms, the narrative self.

This level of selfhood is a complex and continuously evolving self and self-identity that is anchored in the individual’s biography and heavily dependent on language and memory. It is a narrative that contributes to create a self-coherence for ourselves and others. However, Paul Brown will certainly not tell us that he is experiencing everything in the first-person perspective; yet the first-person perspective is the condition for all these complex personality features to emerge.

This is the level of the so-called “minimal” or “basic” self, which implies that all my experiences (perceiving, thinking, remembering) articulate themselves as my experiences. When I am thinking about something, I do not ask myself who is doing the thinking. But this dimension of me (me-ness or mine-ness) is simply a tacit, automatic, and pre-reflective dimension of all my mental life. This elementary sense of selfhood also implies a sense of self-coincidence (I am always at one with myself) and affectively felt self-presence and self-persistence.

This basic self is the most intimate nucleus around which more complex features of the narrative self-coalesce. We believe that the central disorder of schizophrenia and schizotypal disorder consists in the instability of the basic self, leading to varieties of self-alienation, basic identity problems, and a whole area of cognitive and other disturbances.

By the end of the 1990s, we proposed that the fundamental phenotypic feature of the schizophrenia spectrum was an instability in the very basic experiential structures of consciousness (ie, self-disorders), an idea originally 

 by the scholars who founded the concept of schizophrenia (eg, Kraepelin, Bleuler, Schneider, Minkowski).

 Our hypothesis was based on empirical research in US-Denmark high-risk studies and genetic linkage studies and on clinical experience with patients with first-onset schizophrenia.

 During this research, we noticed that the patients with beginning schizophrenia consistently complained of alarming disturbances gravitating around their very sense of being a self (eg, describing an unstable sense of being a self-present, unified, and persistent subject). The patients complained of lacking a core, lacking a kind of substantiality that could function as an anchoring point for their perspective, feelings of being ephemeral, not really present either in themselves or in the world, and experiencing an increasing alienation in the form of a distance between their own sense of being a subject and their thoughts and perceptions.

 and of naturalness and obviousness of the surrounding world and social relations, “other people seem to have some knowledge that I am completely lacking” (ie, in phenomenological terms, disorders of common sense).

 It is not a question of understanding complex cognitive tasks but simply of a lack of attunement and resonance, a failure to grasp proportions, relevance, and significance.

These disorders typically begin in childhood or adolescence and entail a sense of being different from others in a very fundamental way, affecting one’s experience of one’s inner life, the world, and social relations. We believed that a systematic description of self-disorders would rekindle interest in the inner life of patients with schizophrenia. In collaboration with a philosopher and psychiatrists in Denmark, Norway, and Germany, we developed a phenomenologically oriented psychometric instrument for a semi-structured detection and registration of self-disorders, the EASE.

The EASE consists of 5 domains: alienations of cognition, disorders of basic self, disorders of embodiment, disorders of ego-boundaries, and existential changes (

). It contains 57 items, sometimes divided into subtypes. There are also rules of scoring and a manual that introduces certain theoretical issues and provides a practical guide to conducting the interview. The EASE exhibits high interrater reliabilities among trained interviewers (with Kappa around .80) and a high internal consistency (with the Cronbach alpha close to .90).

The EASE has been used in multiple and subsequent empirical studies. These studies uniformly supported our hypothesis, finding a significant hyperaggregation of self-disorders among patients with schizophrenia and schizotypal disorders compared with patients with bipolar psychosis or no psychosis.

 Self-disorders improve differentiation of the schizophrenia spectrum from 

 and correlate weakly or moderately with positive and negative symptoms.

 They exhibit a remarkable temporal stability over 5 to 7 years and predict development of psychosis in the ultra-high-risk population.

 A recent prospective study of adolescents who were help-seeking and nonpsychotic predicted a schizophrenia spectrum disorder (schizophrenia and schizotypal disorder) in early adulthood 7 years later (sensitivity of 78% and specificity of 67% at a cutoff score of 6 EASE-items).

 It is important to realize that self-disorders as a trait feature are equally characteristic of schizotypal disorder and schizophrenic psychosis. There is also an emerging neuroscientific 

The empirical research is consistent with the hypothesis that self-disorders constitute the core phenotype of schizophrenia. One could perhaps consider this statement as a banality or a tautology since the very original concept of schizophrenia was constitutively associated with the clinical evidence of self-disintegration. The Case Vignette illustrates case of the evolution of schizophrenia.

“Olga” is a 31-year-old, single, never married woman. She works in a hospital laboratory as a biochemist. She has always been isolated and felt uncomfortable in the company of others. She always enjoyed being alone and engaged herself in “analyses” (ie, trying to think through important existential questions). She can often become so self-absorbed that she feels disembodied or even nonexistent.

Olga reported 2 former episodes of what she calls “depression” where she stayed at home spending her time on the internet and an inverted day-night rhythm. She was admitted to a psychiatric ward because she was disturbed by thoughts about being switched at birth with another infant. Asked about her name and age, she replied that she could not answer, because she did not know who she was at birth and, therefore, did not know her “true identity.” The substitution became clear to her 8 months ago during a period of restlessness and global feelings of insecurity when she read some old family letters. The style of the letters and some variation in handwriting made it clear to her that the letters signaled the hidden message about her substitution as an infant. She then searched online to find her biological roots; she “discovered” that she was a secret descendant of a Jewish, mystical family known from 200 BC. She had the impression that strangers in the street knew that she was this secret descendant, and she was concerned other people could read her thoughts.

On some levels, Olga was relieved with her finding, because she always felt that something “didn’t add up.” She always felt that she was “weird” or “just wrong,” and she had a tendency to observe herself when talking to other people as if there was an “extra consciousness” about how she should say things and how her face and hands looked. She felt that people never addressed her true self: “When people talk to me, they talk to the other child, and not the real me. That is because I’m substituted with the other child . . . Communication [with other people] goes awry from the beginning because I don’t have my real identity and I’m being judged as a wrong person. . . . There is no connection between who I am and who the other child is, they do not know who I am and I do not know it either. I couldn’t explain that before. All my life, it was just a question mark: Why do I not belong?”

The disorder of basic self and identity is evident in this case, and, it is clearly delusional. Olga developed what is called a primary delusion or a delusional perception. This delusion is not simply a false belief about matters in the empirical world but rather reflects an altered structure of the self (a lack of basic identity) that becomes infused with delusional content.

 Our patient describes a sense of not belonging since early childhood. Later this becomes thematized as a (delusional) idea of being substituted as an infant; moreover, it is a delusion that seems to involve some sort of psychological resolution. Thus, the sense of being different from others precedes finding out what is different.

In German psychiatry this phenomenon has been known as Anderssein.

 It refers to a sense of a fundamentally different existential position that the patient cannot easily conceptualize and verbalize, but uses vague but comprehensive phrases like “I felt wrong.” Experience of Anderssein is quite specific to schizophrenia spectrum disorders but is practically unknown in contemporary psychiatry.

Our patient seems to have disorders of common sense; she feels uncomfortable in the company of others and manifests a phenomenon of “involuntary self-witnessing” where she involuntarily observes herself during interaction with others. This differs from an introspective self-observation because the sense of subjectivity is doubled, so to say, and neither of the 2 consciousnesses functions as a full-fledged subject.

It seems that the self-disorders of this patient play a generative role in her psychopathology. A schematic phenomenological proposal of symptom evolution is outlined in the 

. In general terms, the disorder of basic self in schizophrenia leads to a self-alienation where fragments of the self become another that manifest as voices, external influences, or characteristic delusions.

 has important theoretical and therapeutic consequences. Schizophrenia spectrum is not seen as a contingent mixture and meaningless collection of positive and negative symptoms but as an expression of profound structural changes of subjective life that often cause suffering, other pathological phenomena, and varieties of dysfunctions.

 A familiarity with self-disorders enables the clinician to understand certain meaningful patterns of 

 and re-humanizes the patient-clinician relationship. Furthermore, such familiarity improves differential diagnosis, especially in the early stages of the illness and opens up novel psychotherapeutic approaches. Finally, a pathogenetic focus on a core phenotype may be more useful and fruitful than the study of causally distant symptoms such as delusions and hallucinations.

is professor of psychiatry, Mental Health Centre Glostrup, Faculty of Health and Medical Sciences, University Hospital of Copenhagen; and Center for Subjectivity Research, Faculties of Humanities, University of Copenhagen, Denmark. 

is clinical psychologist and part-time lecturer, Mental Health Centre Glostrup, University Hospital of Copenhagen; and Faculties of Social Sciences, University of Copenhagen. They report no conflicts of interest concerning the subject matter of this article.

An earlier version of this article was posted ahead of print with the following title: 


Rediscovering Disordered Selfhood in Schizophrenia

Rediscovering psychopathology: the epistemology and phenomenology of the psychiatric object

The psychiatric interview: validity, structure, and subjectivity

3. Zandersen M, Parnas J. Identity disturbance, feelings of emptiness, and the boundaries of the schizophrenia spectrum. 

Disordered self in the schizophrenia spectrum: a clinical and research perspective

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7. Nordgaard J, Parnas J. Self-disorders and the schizophrenia spectrum: a study of 100 first hospital admissions. 

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9. Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. 

10. Zandersen M, Henriksen MG, Parnas J. 

A recurrent question: what is borderline?

11. Rasmussen AR, Nordgaard J, Parnas J. Schizophrenia-spectrum psychopathology in obsessive-compulsive disorder: an empirical study. 

12. Nilsson M, Arnfred S, Carlsson J, et al. 

Self-disorders in asperger syndrome compared to schizotypal disorder: a clinical study

13. Nelson B, Thompson A, Yung AR. Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis “prodromal” population. 

14. Raballo A, Preti A. The self in the spectrum: a closer look at the temporal stability of self-disorders in schizophrenia. 

15. Koren D, Tzivoni Y, Schalit L, et al. Basic self-disorders in adolescence predict schizophrenia spectrum disorders in young adulthood: a 7-year follow-up study among non-psychotic help-seeking adolescents. 

16. Nelson B, Lavoie S, Gaweda L, et al. Testing a neurophenomenological model of basic self disturbance in early psychosis. 

17. Sandsten KA, Nordgaard J, Kjaer TW, et al. 

Altered self-recognition in patients with schizophrenia

18. Parnas J, Zandersen M. Phenomenology of a disordered self in schizophrenia: example of an integrative level for psychiatric research. In Kendler KS, Zachar P, Parnas J, Eds. 

Levels of Analysis in Psychopathology: Cross-Disciplinary Perspectives. 

Cambridge: Cambridge University Press; 2020.

19. Parnas J, Henriksen MG. Mysticism and schizophrenia: a phenomenological exploration of the structure of consciousness in the schizophrenia spectrum disorders. 

20. Motobayashi Y, Parnas J, Motobayashi Y, et al. The schizophrenic in the self-consciousness of schizophrenic patients, by Mari Nagai (1990). 

Schizophrenia, consciousness, and the self.

Selfhood: a complex and continuously evolving identity that is anchored in the patient's history and dependent on language and memory. But there is so much more.

Talking to Patients and Rediscovering Disordered Selfhood in Schizophrenia

 in terms of the harm caused to individuals, the damage caused to property, and the financial implications for individuals and society. Between 2010-2014, an estimated 261,330 intentional fires were reported to US municipal fire departments each year, resulting in 440 deaths, and 1310 injuries, and the economic cost of fire setting was estimated to be as high as $328.5 billion per year.

 In the United States, 1 in 100 adults self-reported a lifetime history of deliberate fire setting; 38% of these fire settings persisted beyond the age of 15 years.

 Although estimations of the number of people who set fires within a population are almost certainly imprecise due to methodological limitations such as variations in study design, definition of fire setting used, data analysis techniques, ungeneralizable samples, and response bias, they do provide insight into the scale of the problem.

Various terminology, with somewhat different meanings, has been used within the literature to describe offending behavior that involves fire (

 are terms used to describe intentional fires set within specific contexts (eg, legal or psychiatric), 

 is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Comorbidity is common among adults who set fires. Common diagnoses include personality disorder, psychosis, substance dependence, and mood disorders.

 Reported prevalence rates of pyromania are relatively low, ranging between 0 to 10% of adults who set fires.

 Lower cognitive functioning, intellectual disabilities, and other developmental disorders (eg, autism) are also common, although exact prevalence varies widely depending upon the population sampled (ie, inpatient, community, prison samples).

Despite the development of reliable and valid assessment tools in other areas of offending behavior (eg, sexual offending), the systematic development of tools specific to fire setting has been slower to progress. Nevertheless, several tools have been developed to support the process of systematically collecting and collating clinical information from a range of sources (eg, self and informant reports, behavioral observations, file reviews and clinical assessments) in order to formulate risk and identify treatment needs and intervention plans for individuals who set fires (eg, the Tranah Firesetting Inventory,

 St Andrew’s Fire and Arson Risk Instrument,

 Northgate Firesetter Risk Assessment-2.0,

). These tools do not represent validated risk assessments for fire setting, however, a few fire-specific psychometric measures have been developed to assess fire-related factors (although they lack sufficient evaluation) (

Most recently, the properties of the Fire Interest Rating Scale, Fire Attitudes Scale and the Identification with Fire Questionnaire were analyzed using factor analysis and 4 clinically relevant constructs identified across the 3 scales (ie, the Four Factor Fire Scales): 

However, data collected to validate these measures was limited (eg, ungeneralizable/small samples). Nevertheless, despite fire specific measures not having undergone rigorous reliability and validity evaluations, they can still be used by experienced clinicians as part of a comprehensive assessment.

Those who engage in fire setting are often complex individuals with a diverse set of treatment or intervention needs warranting a specialist approach that reduces their risk of further offending. Most specialist treatment programs are underpinned by a 

approach, targeting a range of criminogenic needs and factors associated with fire setting, including cognitive distortions, poor problem solving, communication difficulties, self-regulation deficits, and relapse prevention. Treatment often includes a component on fire safety education and the consequences of fire setting, while also address­ing a range of associated interpersonal problems (eg, low self-esteem, social competence difficulties, and poor goal setting). 

 summarizes empirically evaluated treatment programs.

Existing interventions that target fire setting behavior in adults include an adapted version of the Fire Awareness Child Education UP (FACE-UP).

 More recently, a cognitive-behavioral group-based intervention for individuals with developmental disabilities called the Northgate Firesetters Treatment program was developed.

 Investigators reported follow-up data for 24 participants (16 men, 8 women) who completed the Northgate Firesetters Treatment Programme, between 4 years and 12 years, 9 months posttreatment. The majority of participants (n = 17) were living in community settings and only 1 female participant was reported to have set a further fire, although suspicions were raised concerning another 2 participants.

 Despite these positive findings, both of these treatment programs are grounded in theoretical perspectives that predate more recent advancements in the field (ie, Functional Analysis Theory,

). Furthermore, their effectiveness are limited in their comparability to other generic interventions, small sample sizes, and lack of robust evidence in terms of their effectiveness in reducing reoffending.

The Firesetting Intervention Programme for Prisoners (FIPP)

 and the Firesetting Intervention Programme for Mentally Disordered Offenders (FIP-MO)

 are based on the latest comprehensive theory of fire setting: the Multi-Trajectory Theory of Adult Firesetting (M-TTAF).

 The M-TTAF integrates parts of existing psychological theory that are supported by empirical evidence including psychological vulnerabilities, developmental factors, cultural factors, social learning factors, biological factors, and contextual factors related to fire setting into a detailed multifactorial theory.

Following a pilot evaluation of the FIPP, positive findings were reported posttreatment on measures related to fire interest/problematic associations with fire, offence supportive attitudes (ie, fire specific, violent, antisocial), locus of control, and anger regulation, which were stable at 3 month follow-up.

 However, the evaluation of the FIPP was conducted solely with adult males in a prison environment; thus, its effectiveness for women and adults with 

intellectual and developmental disabilities

 has yet to be established. Consequently, the FIP-MO was developed to address fire setting and fire-related risk behaviors for both men and women across secure forensic psychiatric hospitals in the United Kingdom. Significant improvements on self-reported interests, beliefs and attitudes about fire, as well as improvement in anger expression.

It is important to note that due to the paucity of research on fire setting by adults with intellectual and developmental disabilities, the generalizability of the M-TTAF to such groups, and the interventions underpinned by it, has yet to be established. Further, despite evidence suggesting that between 0.4% to 43.6% of adults who set fires have intellectual and developmental disabilities,

 no treatment program to date has been rigorously evaluated for this population. Yet, there is evidence to suggest this small but important group have different characteristics and offence specific treatment needs requiring a 

 Nevertheless, the FIPP and FIP-MO represent the first standardized specialist interventions for individuals who deliberately set fires and have been subject to a multisite research evaluation, with results showing that they are effective in reducing some of the fire setters’ key deficits.

Evidence suggests general recidivism is as high as 60% among adults who set fires; reoffending with fire is much lwer with estimates between 4% and 16%.

 However, the operational definition of recidivism, study methodology, setting and sample populations vary widely. Nevertheless, recidivism has been largely associated with younger age, single relationship status, a diagnosis of personality disorder, a history of criminal offending, an interest in fire, and a number of attributes suggestive of childhood disturbance.

 Furthermore, reported length of stay in hospital for adults with intellectual and other developmental 

 and history of fire setting vary from 950 days to 1725 days.

 However, very few studies have included details pertaining to length of stay, which is inevitably effected by many confounding variables, such as mental health, engagement in treatment, previous offending history that are not accounted for within the data.

Whilst there have been significant advancements in our understanding of deliberate fire setting in recent years, further research is urgently needed to understand the etiology of fire setting and to further develop specialist assessment and treatment protocols. In particular, little is known about the relationship between cultural factors and fire misuse, gender-specific factors, or the needs of individuals with intellectual and/or other developmental disabilities. In addition, research on fac­tors that influence the maintenance and desistance process for fire setting will aid the construction of valid and reliable risk assessment tools and ensure individualized treat­ment approaches are taken and practice is evidence based. Focusing on these areas will also ensure that treatment efforts evolve to meet the needs of individuals who have set fires regardless of the treatment setting.

is a postgraduate researcher at the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent, UK. 

 is a lecturer in forensic psychology at theSchool of Psychology, Victoria University of Wellington, New Zealand, and Honorary Lecturer in Forensic Psychology at the University of Kent, UK. 

is a chartered psychologist and lecturer in forensic psychology and intellectual and developmental disabilityat the Tizard Centre, School of Social Policy, Sociology and Social Research, University of Kent. Ms Collins and Dr Barnoux have nothing to disclose regarding this article. Dr Tyler is involved in providing training and evaluating the FIPP and FIP-MO programs and has received funding from Fire and Emergency New Zealand to conduct research on their Fire Awareness Intervention Programme (FAIP) for youth.

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https://www.gov.uk/government/statistical-data-sets/fire-statistics-data-tables

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Diagnostic and Statistical Manual of Mental Disorders, DSM-V. 

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. International Journal of Developmental Disabilities

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 Offenders with Developmental Disabilities

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Journal of Intellectual and Developmental Disability.

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Fire setting is the current preferred term in the literature to describe acts of deliberately started fires regardless of their legal or diagnostic status.

Understanding Adult Fire Setting, Pyromania, and Arson

Lack of empathy is a commonly known feature of narcissistic personality disorder. Relationships are typically shallow and difficult to maintain. What are some other features of NPD? More in this case presentation.

10 Things to Know About Narcissistic Personality Disorder

Psychopathy is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility, among others.

 As a consequence of these criteria, the image of the psychopath is that of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy?

Like healthy people, many psychopaths love their parents, spouse, children, and pets in their own way, but they have difficulty in loving and trusting the rest of the world. Furthermore, 

 as a consequence of separation, divorce, death of a beloved person, or dissatisfaction with their own deviant behavior.

Psychopaths can suffer emotional pain for a variety of reasons. As with anyone else, psychopaths have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, because it is obviously not easy for another person to get close to someone with such repellent personality characteristics. Psychopaths are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most psychopaths are devoid of a stable social network or warm, close bonds.

 are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse socioeconomic circumstances.

 These individuals may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, psychopaths feel inferior to others and know they are stigmatized by their own behavior. Some psychopaths are superficially adapted to their environment and are even popular, but they feel they must carefully hide their true nature because it will not be acceptable to others. This leaves psychopaths with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never be part of it.

Psychopaths are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment because of conflicts with others and unrealistic expectations. Furthermore, many psychopaths are disheartened by their inability to control their sensation-seeking and are repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating, and depressing confrontations, including trouble with the justice system.

As psychopaths age, they are not able to continue their energy-consuming lifestyle and become burned-out and depressed while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.

• Ultimately, they reach a point of no return, where they feel they have cut through the last thin connection with the normal world

• Hidden suffering, loneliness, and lack of self-esteem are risk factors for violent, criminal behavior in psychopaths

Social isolation, loneliness, and associated emotional pain in psychopaths may precede violent criminal acts.

 They believe that the whole world is against them and eventually become convinced that they deserve special privileges or the right to satisfy their desires. As psychopathic serial killers Jeffrey Dahmer and Dennis Nilsen expressed, violent psychopaths ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently, their sadness and suffering increase, and their crimes become more and more bizarre.

Dahmer and Nilsen have stated that they killed simply for company.

 Both men had no friends and their only social contacts were occasional encounters in homosexual bars. Nilsen watched television and talked for hours with the dead bodies of his victims; Dahmer consumed parts of his victims’ bodies in order to become one with them: he believed that in this way his victims lived further in his body.

The image of the psychopath is that of a cold, heartless, inhuman being. But do all psychopaths show a complete lack of normal emotional capacities and empathy?

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