The research does not support the old belief that psychopathy is untreatable. Treatment works best when it starts early, rewards good behavior rather than relying on punishment, and is built for people with psychopathic traits.

This guide gathers key studies on psychopathy in one place. I’ve tried to include what it is, how it develops, and how it responds to treatment. The treatment sections list studies by age group with a plain-language summary of what they found and a link to the source. Full citations are at the end.

A few key terms used:

  • Callous-unemotional (CU) traits: low empathy, guilt and concern for others in children. Researchers treat these as an early form of psychopathic traits.
  • PCL-R: the Psychopathy Checklist-Revised, the most common clinical measure of psychopathy.
  • Randomized controlled trial: a study that randomly assigns people to a treatment or a comparison group. It is the strongest test of whether a treatment works.

Reviews (Overall Research)

Reviews of the evidence find treatment more promising for young people than for adults. They also find that pessimism about treatment rests on weak or outdated studies.

Salekin (2002), Clinical Psychology Review
The first major challenge to the belief that psychopathy cannot be treated.
Salekin Lab
Salekin, Worley & Grimes (2010), Behavioral Sciences & the Law
Youth: 6 of 8 studies showed benefits. Adults: 3 of 8 showed gains. The authors say no one should be ruled out of treatment because of psychopathy.
abstract
Polaschek (2015), Psychiatry, Psychology and Law
Argues that misunderstandings of psychopathy shape how offenders are handled. Group programs for high-risk offenders can produce change.
article
Olver (2016), Journal of Community Safety and Well-Being
Reviews failed and encouraging programs. People with psychopathy are about 30% more likely to drop out, so keeping them in treatment matters. Free to read.
full text
Larsen (2019), Kennedy Institute of Ethics Journal
Argues the “untreatable” view comes from flawed older research and stands in the way of better treatment.
record

Treatment in Children

Parent training that emphasizes warmth and rewards can reduce callous-unemotional traits in children as young as 3. Prevention programs show benefits that last for decades.

Waddell et al. (2018), Evidence-Based Mental Health
Reviewed 37 trials over 50 years. Several prevention programs cut later conduct disorder and adult antisocial personality disorder, with benefits lasting up to 35 years.
article
Kimonis et al. (2019), Journal of Clinical Child & Adolescent Psychology
A parent-child therapy adapted for CU traits (PCIT-CU) reduced CU traits and behavior problems and increased empathy in children aged 3 to 6. Gains held at 3 months.
abstract
Fleming et al. (2022), Behavior Therapy
Randomized trial of 43 families. Children improved in both standard and adapted therapy, but only the adapted version kept behavior gains after treatment ended.
abstract
Fleming et al. (2023), Research on Child and Adolescent Psychopathology
Children with primary CU traits kept their gains after therapy. Children with secondary CU traits, often linked to anxiety or trauma, slipped back.
article
Perlstein et al. (2023), Journal of Child Psychology and Psychiatry
Many treatments for conduct problems also help children with high CU traits. High-quality parenting programs show the most promise for reducing the traits themselves.
commentary
Marsh (2024), Scientific American
Argues that aggression disorders are real, treatable conditions rather than the result of bad parenting. Reward-based parent training has the strongest evidence.
article

Treatment in Adolescents

Two programs for detained teens with high psychopathic traits cut violent reoffending or reduced the traits themselves.

Caldwell & Van Rybroek (2001), International Journal of Offender Therapy and Comparative Criminology
Introduced the “decompression” model at Mendota Juvenile Treatment Center in Wisconsin, which rewards positive behavior instead of relying on punishment.
program profile
Caldwell, Skeem, Salekin & Van Rybroek (2006), Criminal Justice and Behavior
141 young male offenders. Those in conventional detention were about twice as likely to commit violent crimes within 2 years of release as those treated at Mendota.
abstract
Ribeiro da Silva et al. (2021), Journal of Consulting and Clinical Psychology
119 detained boys in Portugal. A program aimed directly at psychopathic traits (PSYCHOPATHY.COMP) reduced them more than usual care, and the gains held at 6 months.
article

Treatment in Adults

The adult evidence is thinner, but recent randomized trials show that structured therapies can reduce aggression and reoffending. Two of these trials studied antisocial or other personality disorders, which overlap with psychopathy but are not the same.

Fonagy et al. (2025), The Lancet Psychiatry
313 men on probation with antisocial personality disorder. Mentalization-based therapy cut aggression by about half and offenses by 46% over three years, compared with probation alone.
UCL summary
Moosburner et al. (2024), preprint on CrimRxiv
187 offenders in a German treatment facility. Psychopathy scores dropped during treatment, and the core interpersonal and emotional traits dropped most. Not yet peer-reviewed.
preprint
Bernstein et al. (2023), Psychological Medicine
103 violent offenders with personality disorders in Dutch high-security hospitals. Schema therapy beat usual treatment, with faster progress toward supervised and unsupervised leave.
abstract
Chakhssi et al. (2014), Psychotherapy
A case study of one psychopathic patient whose PCL-R score dropped after schema therapy. A single case, but the first of its kind.
article

Understanding Psychopathy

These works shaped how psychopathy is defined. Several separate primary psychopathy, rooted in temperament, from secondary psychopathy, driven mainly by environment.

Cleckley (1941; 5th ed. 1976), The Mask of Sanity
The classic clinical portrait of psychopathy. It sets out 16 traits and describes people who seem outwardly normal and often charming.
Book
Karpman (1947), Psychoanalytic Review
Proposed that true, or “idiopathic,” psychopathy differs from antisocial behavior caused by other conditions.
Journal archive
Karpman (1948), American Journal of Psychiatry
Argued the psychopathy label was overused, and that many people given it had other, treatable problems underneath.
article
Lykken (1957), Journal of Abnormal and Social Psychology
Found that people with primary psychopathy showed low anxiety and struggled to learn to avoid punishment. This became the low-fear theory.
article
Mealey (1995), Behavioral and Brain Sciences
An evolutionary model. Primary sociopathy is largely inherited, while secondary sociopathy develops in response to harsh environments and may be more open to prevention.
article
Lykken (1995), The Antisocial Personalities
Distinguished fearless-temperament psychopaths from sociopaths shaped by poor parenting, and argued much antisocial behavior is preventable.
Book
Lasko & Chester (2021), Personality Disorders: Theory, Research, and Treatment
Followed over 1,000 young offenders for 7 years. Youth higher in psychopathy gained impulse control faster, especially those who did not reoffend.
summary

References

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  • Caldwell, M. F., Skeem, J., Salekin, R., & Van Rybroek, G. (2006). Treatment response of adolescent offenders with psychopathy features: A 2-year follow-up. Criminal Justice and Behavior, 33(5), 571–596. https://doi.org/10.1177/0093854806288176
  • Caldwell, M. F., & Van Rybroek, G. J. (2001). Efficacy of a decompression treatment model in the clinical management of violent juvenile offenders. International Journal of Offender Therapy and Comparative Criminology, 45(4), 469–477.
  • Chakhssi, F., Kersten, T., de Ruiter, C., & Bernstein, D. P. (2014). Treating the untreatable: A single case study of a psychopathic inpatient treated with schema therapy. Psychotherapy, 51(3), 447–461. https://doi.org/10.1037/a0035773
  • Cleckley, H. (1976). The mask of sanity (5th ed.). Mosby. (Original work published 1941)
  • Fleming, G. E., Neo, B., Briggs, N. E., Kaouar, S., Frick, P. J., & Kimonis, E. R. (2022). Parent training adapted to the needs of children with callous-unemotional traits: A randomized controlled trial. Behavior Therapy, 53(6), 1265–1281. https://doi.org/10.1016/j.beth.2022.07.001
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  • Lasko, E. N., & Chester, D. S. (2021). What makes a “successful” psychopath? Longitudinal trajectories of offenders’ antisocial behavior and impulse control as a function of psychopathy. Personality Disorders: Theory, Research, and Treatment, 12(3), 207–215. https://doi.org/10.1037/per0000421
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