Is There any Hope for the Aging Psychopath?

New research shows why, for psychopaths, it's the bad who die young.

Posted Jul 16, 2019

Personality disorders are, by definition, chronic conditions that affect people throughout their entire lives. People with antisocial personality disorder, as one of these conditions, should therefore remain the same as they get older. Once a psychopath, always a psychopath, according to this reasoning.

Why, then, does antisocial behavior seem to decrease in later life? It has long been known that rates of criminality are lower among people in their 50s, 60s, and beyond, a fact referred to as one of the “brute facts” of criminology (Matthews & Minton, 2018).

Research on antisocial behavior, furthermore, distinguishes between the “adolescence-limited” and “life course persistent” people with this disorder (Moffitt, 2018). Since the majority of people with antisocial qualities are of the adolescence-limited variety, this means that they should settle down into a more conforming lifestyle as they adapt more to life’s requirements for getting along with their fellow citizens.

Consider what these findings about psychopathy might mean in your own life. If you’re unlucky enough to have a psychopathic boss, for example, over time this person will stop misusing company funds and should stop intimidating you and your fellow employees.

Perhaps you have a relative with a long history of lying and taking advantage of other family members. With age, this relative should be a bit more mellow, and maybe even become someone you can actually trust.

However, researchers who study personality disorders believe that the age-crime relationship reflects no change in the underlying traits of callousness and egocentricity that form one component of psychopathy (Boudreaux et al., 2019).

Thus, if the underlying traits of the inability to experience remorse, guilt, and empathy don’t change, your relationships with the psychopaths in your life aren’t going to get better as they age. They’ll still be manipulative, egocentric, and callous and you still won't be able to trust them.

You might wonder why psychopaths would tone down their behavior when the personality that feeds that behavior remains constant. Maybe that psychopathic boss of yours is a 60-something and, as far as you know, still abuses the system to his or her advantage. That older relative still seems to take pride in scamming people, and you continue to feel you need to watch your back.

These people haven’t changed, and they’ve lived a good long life. New research on the epidemiology of antisocial behavior suggests that, as people with this disorder get older, they don’t actually settle down. Instead, they’ve managed to avoid the early deaths that take their antisocial counterparts out of the population.

The people you know who've avoided this early death are the same as ever, they just have managed to avoid being caught.

Columbia University’s Anna Krasnova and colleagues (2019) reveal in a new study that it in fact, unlike the words of Billy Joel’s song that “only the good die young,” it’s really the opposite, and it is the “bad” who die young.

After analyzing 27 years of data from the national Epidemiologic Catchment Area (ECA) study along with National Death Index records, Krasnova and her fellow researchers conclude that antisocial personality disorder is strongly linked to early mortality.

The age-crime curve reflects no developmental changes in psychopaths, but instead is a function of who’s around in later life to commit crimes. Studies showing antisocial behavior diminishes in middle and old age are due to the fact that those who died can, obviously, not be tested for their psychopathic qualities. 

Getting into the details of the study, the ECA was the basis for much of what you read in the literature and popular press about the prevalence of various psychological disorders. This massive study was conducted on representative samples living in five metropolitan study sites in which trained research assistants interviewed both household members and institutionalized individuals.

The original study was conducted between the years of 1979 and 1982, and the 2019 study included over nearly 16,000 participants, of whom 478 were in prison. In the 27 years of the course of the study, 6868 persons had died; their death records included date (month and year) as well as cause of death. There were 420 with antisocial personality disorder, and of these, 119 had died.

Applying the appropriate statistical controls, the Krasnova et al. team found that individuals with antisocial personality disorder were over 4 times as likely as non-antisocial individuals to die over the course of the study. Their highest rates of death were due to HIV infection, cancer, chronic lung disease, and suicide.

After removing these causes, there was no effect of antisocial personality disorder on death due to heart disease or accidents. Non-antisocial personality individuals lived a median of 13 years longer than those with the disorder.

These findings become more impressive when you consider the survival rates of people with and without antisocial personality disorder, Other studies have shown higher mortality rates for people with antisocial personality disorder, but this is the first one to link their shorter life expectancy with cancer and chronic lung disease.

Smoking, a risky health behavior, would seem to account for this finding. The higher risk of dying from HIV appeared, according to the authors, to be linked with a high prevalence of needle sharing, multiple sexual partners, and substance use.

The data on aging and antisocial personality disorder are, based on this study, biased by the dropping out of those who died. There’s no reason to expect that the psychopathic people you know will become any more humane, empathic, or honest as they get older. As long as they maintain their health, the antisocial can continue their exploits for as long as they are alive.

This is not a comforting thought. From a public health perspective, Krasnova and her fellow researchers believe that the findings indicate a need for prevention of the potentially psychopathic at a very young age. As they note, “Despite the challenges that arise, antisocial traits can be reduced, especially if intensive treatment is introduced early” (p. 623).

To sum up, you might feel like giving up on the older psychopaths in your life, even as you try to steer clear of them. Even if they can't be helped, intervening early with the children and teens who appear to be headed in the antisocial direction can pave the way for them lead longer and more fulfilling lives.

References

Boudreaux, M. J., South, S. C., & Oltmanns, T. F. (2019). Symptom-level analysis of DSM–IV/DSM–5 personality pathology in later life: Hierarchical structure and predictive validity across self- and informant ratings. Journal of Abnormal Psychology, 128(5), 365-384. doi: 10.1037/abn0000444 10.1037/abn0000444.supp (Supplemental)

Krasnova, A., Eaton, W. W., & Samuels, J. F. (2019). Antisocial personality and risks of cause-specific mortality: Results from the Epidemiologic Catchment Area study with 27 years of follow-up. Social Psychiatry and Psychiatric Epidemiology, 54(5), 617-625. doi: 10.1007/s00127-018-1628-5

Matthews, B., & Minton, J. (2018). Rethinking one of criminology's 'brute facts': The age-crime curve and the crime drop in Scotland. European Journal of Criminology, 15(3), 296-320. doi: 10.1177/1477370817731706

Moffitt, T. E. (2018). Male antisocial behaviour in adolescence and beyond. Nature human behaviour, 2, 177-186.