Psychiatric Quarterly [psaq] PH140-378644-02 October 4, 2002 14:1 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 74, No. 1, Spring 2003 (
SUBTYPES OF PSYCHOPATHY: PROPOSED
DIFFERENCES BETWEEN NARCISSISTIC,
BORDERLINE, SADISTIC, AND
Carolyn Murphy, Ph.D. and James Vess, Ph.D.
Atascadero State Hospital (ASH) is a maximum-security forensic hospital that
houses male patients with a wide range of psychiatric diagnoses. Psychopaths
at this institution appear to be a heterogeneous group of individuals who,
while sharing core personality characteristics, manifest substantial variabil-
ity in their behavior. Identifying subtypes within this clinical classiﬁcation can
have implications for patient treatment and management, as well as for the
safety of the staff who work with them and for the communities to which they
will eventually return. Several means of identifying subtypes have been pro-
posed in the literature, and potential subgroups have been identiﬁed. Clini-
cal observations at ASH have suggested 4 possible subtypes of psychopathy:
narcissistic, borderline, sadistic, and antisocial. Issues related to the concep-
tualization of psychopathy are addressed, recognizing that additional data are
needed to understand the observed variations in cases of psychopathy.
KEY WORDS: psychopathy; narcissism; sadism; borderline.
The views expressed are those of the authors, and do not necessarily reﬂect the position
of Atascadero State Hospital or the California Department of Mental Health.
All authors are afﬁliated with the Atascadero State Hospital, Atascadero, California.
Address correspondence to James Vess, Evaluation and Outcome Services, Atascadero
State Hospital, P.O. Box 7001, Atascadero, California 93423-7001; e-mail: jvess@
2003 Human Sciences Press, Inc.