Can psychopaths learn to feel empathy?

People with psychopathy often embody traits such as being egocentric, manipulative, violent and probably criminal. But can people exhibiting these characteristics overcome them and learn how to feel empathy?

Before diving into this question, it's important to know that the medical definition of psychopathy is incredibly complicated, and experts are still debating what this term should encompass. "Psychopathy is not a diagnosis in itself," Katarina Howner, a neuroscientist at the Karolinska Institute in Sweden, told Live Science. "It's a personality disorder with really close connections to antisocial and criminal behavior."

Like other personality disorders, this condition is identified through life History interviews in which psychiatric professionals probe every aspect of an individual's life, looking for patterns of psychopathic traits, such as callousness and quickly-triggered aggression. Affected individuals are at particularly high risk of committing violent crimes or reoffending after release from prison.

"People with psychopathic traits are really focused on themselves and their own needs," Howner explained. "They have a lack of empathy and they don't experience feelings of shame or guilt. There's a grandiosity and impulsivity which means they think that they can do anything without consequence."

However, this doesn't mean people with psychopathy don't have any empathy at all, Howner said. Psychologists break this complex emotion down into several different sub categories.

"Affective or emotional empathy is where you feel the emotions that others are showing. You have a kind of emotional resonance with the other person, and this is something psychopaths struggle with," she said. "But cognitive empathy is more like mentalization. That is, you can think how another person is thinking or feeling. Psychopaths are usually good at this and use it to manipulate people."

Related: Are humans inherently violent?

This apparent lack of emotional empathy is what makes psychopathic individuals seem cold and cruel. However, studies consistently show people with psychopathy have the capacity to experience this type of empathy under the right conditions. "When you deliberately focus people with psychopathy on labeling an emotion in a photograph in an unambiguous way (meaning the face is showing 100% of that emotion), they can do that accurately," Arielle Baskin-Sommers, a psychologist at Yale University told Live Science. "If you flash the faces really quickly or blend the emotions, then people with psychopathy seem to struggle." The difficulty, she said, is not that psychopaths lack this empathy but that they lack the natural ability to do it easily.

But is this a skill that psychopaths can learn? There's every reason to believe so, Baskin-Sommers told Live Science. That they can experience empathy and that this ability seems to change depending on the situation is a promising sign. 

So why does this behavior develop in the first place? Scientists aren't exactly sure, although evidence suggests it's a mixture of genetic and environmental factors. But while the cause is unknown, psychopathy's effect on the brain is well-established.

Studies have shown profound differences in both the structure of the brain and how different brain regions communicate in psychopathic individuals.

"The size of the structure and function of the amygdala, which is a region of the brain important for our emotional processing, reliably shows up as different in people with psychopathy," Baskin-Sommers said. "We also tend to see differences in prefrontal structures of the brain that have to do with general cognition and control of behavior. People with psychopathy fundamentally have very different brains." These neurological differences mean that psychopathic individuals don't process emotions in the same way as individuals without psychopathy do and this physical disparity is difficult to overcome.

Current treatments rely on a combination of approaches including cognitive behavioral therapy and medication, but there's no simple cure to help psychopathic individuals easily experience empathy. Strategies focusing on rewarding good behaviors have shown some success in helping patients adapt to society and both Howner and Baskin-Sommers said that this should be the focus of interventions, rather than developing empathy.

"Current data suggest that psychopathy is no more or less untreatable than any other psychiatric disorder," Baskin-Sommers said. "There's been an unfortunate narrative about psychopathy that these people are fundamentally evil, but society needs to realize that this is a condition that deserves support and necessitates treatment."