A multilevel framework for distinguishing psychopathy from related disorders

Although psychopathy is not a standalone diagnosis in current psychiatric classification systems, it remains widely used in forensic contexts and can have significant consequences for individuals within the legal system. Consequently, it is critical that the field be able to distinguish psychopathy from other mental disorders with over=lapping symptom presentations. This review proposes a multilevel theoretical framework for understanding how psychopathy differs from related disorders when mechanistic and dispositional factors are considered alongside behavioral symptoms. It illustrates how disorders overlapping with psychopathy at one level of analysis (e.g., chronic antisocial behavior and aggression) diverge from it at others, particularly the mechanistic level (e.g., attentional functioning, threat reactivity, empathy processing) and dispositional level (e.g., callous-unemotional traits). It further considers how contextual factors modulate whether psychopathic features are rewarded or criminalized and how this may affect their interpretation. By identifying features that distinguish psychopathy across levels of analysis, the framework clarifies what makes psychopathy a distinct construct, with implications for case formulation, treatment, and forensic assessment.