Psychopathy is an extremely researched area of psychology, although this diagnosis is not in the DSM IV. Dr. Robert Hare is the recognized expert in this field and has defined the concept. What has this to do with narcissism? Glad you asked. The clinical tool used to diagnose psychopathy, as developed by Hare, is called the PCL-R. Half of the checklist (Factor 1) correlates with narcissistic personality disorder and defines the core personality traits of psychopathy . The Wikipedia entry on the PCL-R is concise and provides a decent introduction to this diagnostic device.
What is becoming more well-recognized in professional circles is that all psychopaths are narcissists. We are supposed to believe, though, that not all narcissists are psychopaths. I'm becoming less and less sure of this being true. If psychopathy is only identified as such if a person demonstrates certain behaviors, yes, we can accurately state that not all narcissists are psychopaths. But one of Dr. Hare's assertions based on his profoundly extensive research is that the vast majority of psychopaths live "peacefully" among us. Most do not commit violent crimes. See "Snakes in Suits" and "Without Conscience". Dr. Hare has been leading the charge to change the DSM IV criteria to move away from a behavior-only checklist (as it is in the DSM III-R) towards the more comprehensive checklist that includes narcissism as the core definition of the personality of the psychopath. One of the reasons for this is his recognition of the fact that some psychopaths slip through the cracks because the context of their lives has allowed them to circumvent certain behaviors such as violent crimes or other anti-social behaviors. So if a psychopath can only be diagnosed as psychopathic by exhibiting certain behaviors then he is allowed to continue his predations with little to no interference from the law or the psych community. Worse yet, the undiagnosed psychopaths end up in remedial programs that worsen their behaviors. Psychopaths require a much different approach than we take with non-psychopaths otherwise we unleash a more sophisticated manipulator onto the general public. Dr. Hare presents a strong case for using a more comprehensive tool to diagnose psychopathy. He insists the tool must include an analysis of personality type/affect/interpersonal impressions if doctors are going to accurately detect a higher percentage of these people. The constant with psychopaths is not how they behave but who they are i.e. personality traits. This is why Dr. Hare has included the checklist for narcissistic personality traits into the PCL-R. This checklist, which includes personality type, is especially important in prison populations where recidivism rates for certain offenders must be considered. The PCL-R has been proven to be the best predictor of recidivism that exists. Dr. Hare's intentional movement away from behavior-only based checklists to a more comprehensive checklist which includes personality traits has resulted in a highly effective tool for detection of psychopathy.
The question we need to be asking ourselves is: at what point does the narcissist become a full-blown psychopath? Is there a clear demarcation line, or is it all kind of fuzzy? Was Jim Jones only a narcissist who suddenly became a psychopath the day he got all his followers to drink the Kool-Aid? That kind of reasoning defies logic. If he was a psychopath on that fateful day, then should we not reasonably conclude he was a psychopath long before this violent act? If psychopathy is only present once violence has been employed then the logic works. But when the leading research on the subject keeps clarifying that psychopathy can be present without violence then we really need to re-think the way we categorize.
Speaking of categorization...I think we would all do well to remember the rather arbitrary lines that have been drawn up for us by the psych community. They are allowed the freedom to re-draw the lines as they deem necessary which only tends to prove the non-scientific nature of the categorization. What I have been glad to see is how much true science has been employed in the research on psychopathy. The result of which is showing that narcissists come in many flavors...some of which we call psychopaths.
At this point in time it is looking like the only clear difference between the malignant narcissist and the narcissistic psychopath is the level of risk-taking they are comfortable with. Considering that predatory behavior is not just the realm of the psychopath but also one of the defining characteristics of narcissists, we should really consider the narcissist to be just as dangerous to human society as the psychopath even if we are not willing to call them psychopaths. Narcissists leave a trail of human devastation and ruined lives in their paths. They waltz through life rarely detected because they don't actually leave a bunch of bodies buried under their houses like John Wayne Gacy. No, they just cruelly destroy souls which is arguably just as horrid as what the violent psychopath does.
Narcissist or psychopath? Seems the differences are fewer than the similarities. Be aware that either way you are dealing with a psychological predator. Safety is only achieved through distance. You've been warned.