Secondary Psychopathy as the Adult Manifestation of ADHD
Secondary Psychopathy as the Adult Manifestation of ADHD
Secondary psychopathy and ADHD are psychiatric phenotypes which have been framed in very opposing ways: ADHD is typically seen as a childhood disorder, secondary psychopathy as an adult disorder; ADHD is a neurodevelopmental disorder, secondary psychopathy a personality disorder; ADHD is a disability, secondary psychopathy is a character flaw; yet, despite their framing, and widespread consideration as distinct and existing in separate domains, these two phenotypes are remarkably similar, with nearly identical correlates and outcomes, and similar underlying neurobiology. The separation of these disorders, I argue, is scientifically invalid and based on social biases, and that the consideration of them as separate has led to poor and incomplete characterization of ADHD and secondary psychopathy, when in reality they are the same condition including the features of both ADHD and secondary psychopathy.
Disruptive Behavioral Disorders
ADHD is grouped with conduct disorder (CU) and oppositional defiant disorder (ODD) under the category of "disruptive behavioral disorders", which aside from ADHD are only diagnosed in childhood. These disorders commonly occur together, and factor analysis of these behavioral disorders shows that, depending on the amount of factors extracted, ADHD symptoms load on one higher order factor, and symptoms of ODD and CU load on a second higher order factor (Bezdijan et al. 2012)(Martel et al. 2010)(Friedman-Weieneth et al. 2009). The symptoms of ADHD involve poor organization, planning, impulsivity, distractibility, poor self control, and motivation difficulties; the symptoms of ODD and CU involve aggression, antagonism, rule breaking, criminality, and a lack of empathy (Bezdjian et al. 2012). ADHD correlates most strongly with disinhibition out of the five factor pathological personality trait model (Smith & Samuel 2017), and though no studies investigate ODD & CD in relation to the five factor pathological trait model, conduct disorder correlates most strongly with low agreeableness, and ADHD with low conscientiousness (Smith & Samuel 2017), which respectively correspond to antagonism and disinhibition (Widiger et al. 2017). The higher order structure of disruptive behavioral disorders mirrors that of psychopathy: one factor corresponding to antagonism, and a second factor corresponding to disinhibition (Widiger et al. 2017)(Cloudfindings 2023). Conduct disorder is considered to be the child form of primary psychopathy, and is diagnosed as antisocial personality disorder after the age of 18 (Myers et al. 1998), antisocial personality disorder being a diagnosis characterized by high primary psychopathy, secondary psychopathy, or both (Cox et al. 2013). Like psychopathy, ADHD, CU and ODD all load onto a common factor at the highest level, that can be split into an ADHD and ODD+CU factor (Bezdjian et al. 2012). Overall, ADHD, CU, and ODD form a structure resembling that of psychopathy, with two factors corresponding to antagonism/low agreeableness and disinhibition/low conscientiousness, as with primary psychopathy and secondary psychopathy.
When Disability Becomes a Character Flaw
One trait of secondary psychopathy is called blame externalization - a tendency to blame behaviors and life events on external circumstances and causes, but is blame externalization necessarily wrong, if one's brain does not allow them to inhibit impulses, perform executive functions, and maintain a constant sense of identity and goals? The symptoms of secondary psychopathy and ADHD become essentially identical when the implication of moral blame is removed. The secondary psychopath fails to follow through on financial and social obligations because he is irresponsible and careless, the child with ADHD fails to turn in their homework because they're forgetful and cannot manage time. The child with ADHD engages in hyperactivity and fun activities over work because they are under stimulated and need more stimulation to captivate them, the secondary psychopath engages in risky and deviant behaviors because they are reckless, amoral, and hedonistic. Many more parallels can be made between ADHD and secondary psychopathy, but the common theme seems to be that secondary psychopathy is described in terms of an amoral character flaw, and ADHD as an unchosen disability, with ADHD being associated with children who are viewed as innocent and not knowing any better, secondary psychopathy being associated with adults who are viewed as agentic and in control, shown in the fact that antisocial personality disorder cannot be diagnosed in children, and that ADHD is usually diagnosed in childhood (Myers et al. 1998). The common misconception that children grow out of ADHD also shows this bias - it's expected that adults should not be affected by things and have total agency and choice over their own psychology and behavior, anything unpleasant to be attributed to a chosen character flaw. The double standard narrative is observable in the clinical literature in how it is discussed, what hypotheses are tested, and how it is measured and characterized. For example, Jordan Peterson describes ADHD as “bored boys who need to play” that modern society should accommodate for, blaming modern society for the failure of boys with ADHD - on the other hand, he describes secondary psychopaths as parasitic, lazy, amoral hedonists who blame everyone else for their problems.
The Overlap of ADHD and Secondary Psychopathy
ADHD and secondary psychopathy share a wide range of correlates and characteristics [Table 1]. Antisocial personality disorder symptoms are shown to predict ADHD symptoms more strongly than any other personality disorder (Smith & Samuel 2017), and 65% of people with AsPD meet criteria for ADHD (Semiz et al. 2008). Studies assessing the prevalence of AsPD in persons with ADHD generally find higher prevalence of AsPD but only a small increase from those without ADHD - this is possibly due to AsPD having criteria of both primary and secondary psychopathy, and primary psychopathy relates to aspects of ADHD opposite to secondary psychopathy, for example enhanced executive functioning in primary psychopaths (Ross et al. 2007). Inattentiveness, impulsivity, and emotional dysregulation emerge as factors when measuring child psychopathy and correlate highly with parent and teacher ratings of ADHD (Breaux et al. 2020), and the other factors of psychopathy.
Implications for Understanding ADHD and Secondary Psychopathy
ADHD and secondary psychopathy are diagnoses that largely refer to the same thing but have been treated distinctly due to social biases and the history of these diagnoses. At the core of ADHD/secondary psychopathy is low conscientiousness, a personality trait that relates to impulse control, long term thinking, conformity, disgust sensitivity & disgust/purity based morality, responsibility, orderliness, attention to detail, abstinence from short term reward, self discipline, and persistence. What is known about ADHD can be transferred to secondary psychopathy and vice versa, and this would paint a complete picture of the condition as they have been studied and conceptualized in very different ways, in such they represent incomplete halves of what is a whole condition. For example, the tendency to have strong interests which one pursues over socially prescribed activities and the development of talent at the expense of academic achievement has been recognized in ADHD (Schirduan et al. 2008)(DeWitt 2008) but not secondary psychopathy, and social deviance and nonconformity are recognized in secondary psychopathy but not so much in ADHD. Similar positive outcomes such as entrepreneurship and creativity, and negative outcomes like criminality and homelessness show evidence that the same “strengths” and “weaknesses” are shared between ADHD and secondary psychopathy. Recognizing that ADHD and secondary psychopathy are the same disorder should lead to increased acceptance of ADHD, as currently many symptoms of ADHD are attributed to personal flaws and having their explanation as being caused by ADHD rejected, such as non-conformity. Secondary psychopathy should also be viewed more so in the light of a variation of personality that confers true disability but strengths as well, more similarly to ADHD, rather than a character flaw associated with negative outcomes.
1. Friedman-Weieneth et al. (2009) The disruptive behavior rating scale—parent version (DBRS-PV) factor analytic structure and validity among young preschool children
2. Martel et al. (2010) The structure of childhood disruptive behaviors
3. Bezdjian et al. (2012) The structure of DSM-IV ADHD, ODD, and CD criteria in adolescent boys: A hierarchical approach
4. Ehrler et al. (1999) Extending Big‐Five theory into childhood: A preliminary investigation into the relationship between Big‐Five personality traits and behavior problems in children
5. Smith & Samuel (2017) A multi-method examination of the links between ADHD and personality disorder
6. Widiger et al. (2017) Five-Factor Model and Personality Disorder
7. Cloudfindings (2023) General Psychopathology Masks the Associations Between Psychiatric Disorders and Personality Traits
8. Myers et al. (1998) Progression from conduct disorder to antisocial personality disorder following treatment for adolescent substance abuse
9. Cox et al. (2013) Using the Psychopathic Personality Inventory to identify subtypes of antisocial personality disorder
10. Bernardi et al. (2013) The lifetime impact of attention-deficit hyperactivity disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
11. Uzun et al. (2006) Substance Use Disorders in Men with Antisocial Personality Disorder: A Study in Turkish Sample
12. North et al. (1998) Correlates of Early Onset and Chronicity of Homelessness in a Large Urban Homeless Population
13. Murillo et al. (2016) Childhood Attention-Deficit/Hyperactivity Disorder and Homelessness: A 33-Year Follow-Up Study
14. Fletcher & Wolfe (2012) Long-term Consequences of Childhood ADHD on Criminal Activities
15. Drislane et al. (2015) Distinct Variants of Extreme Psychopathic Individuals in Society at Large: Evidence from a Population-Based Sample
16. Walker et al. (2020) Disinhibition predicts both psychopathy and entrepreneurial intentions
17. Verheul et al. (2016) The association between attention-deficit/hyperactivity (ADHD) symptoms and self-employment
18. Ando et al. (2018) Psychotic traits in comedians
19. Stolte et al. (2022) Characterizing Creative Thinking and Creative Achievements in Relation to Symptoms of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder
20. Ross et al. (2007) Symptoms of Executive Dysfunction are Endemic to Secondary Psychopathy: An Examination in Criminal Offenders and Noninstitutionalized Young Adults
21. Brown (2009) ADD/ADHD and impaired executive function in clinical practice
22. Yildirim (2016) A treatise on secondary psychopathy: Psychobiological pathways to severe antisociality
23. Volkow et al. (2009) Evaluating Dopamine Reward Pathway in ADHD
24. Semiz et al. (2008) Effects of Diagnostic Comorbidity and Dimensional Symptoms of Attention-Deficit–Hyperactivity Disorder in Men with Antisocial Personality Disorder
25. Pai et al. (2022) New insights into precocious puberty and ADHD: a nationwide cohort study
26. Sadeh et al. (2020) Psychopathic Traits, Pubertal Timing, & Mental Health Functioning in Justice-Involved Adolescents
27. Jonason et al. (2018) Love, Sex, and Personality Pathology: A Life History View of Personality Pathologies and Sociosexuality
28. Schirduan et al. (2008) How ADHD Students Are Smart
29. DeWitt (2020) ADHD, Willpower, and Interest: A Positive Approach
30. Breaux et al. (2020) Examining Psychopathic Traits in Children Using the Child Psychopathy Scale – Revised
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