Psychiatrists have believed that psychopaths are defined by qualities of callousness, lack of emotion, and coldness. They lack empathy, in other words. But a new study identifies that not all psychopaths — or adolescents showing signs of pre-psychopathy — have these qualities, and that diagnosing psychopathy is a lot more complicated.

Published in the Journal of Abnormal Child Psychology, the study argues that this belief actually prevents doctors from properly treating people who have been diagnosed with psychopathy, or have been diagnosed with precursors of it.

What is a psychopath? Despite popular belief, it’s quite different from a sociopath; psychopaths are generally considered to have emotional and chemical imbalances on a genetic level (they barely have a moral compass, or don't have one at all), while sociopaths tend to develop their skewed moral compass throughout childhood and adulthood. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists psychopathy under Antisocial Personality Disorders (ASPD), characterized by a disregard for laws and rights of others, inability to feel remorse or guilt, and a penchant for violence.

Typically, psychiatrists and doctors believe that psychopaths can’t be cured or really treated, even. Psychopaths, particularly adults, don’t fear punishment or social isolation.

But the new study, which was completed at the University of Vermont, argues that if caught early on enough, psychopathic traits in adolescents might be able to be treated. The researchers examined 150 male and female young people who lived in juvenile detention centers. They were between the ages of 11 and 17, had been classified as “callous and unemotional” (CU), and showed extreme anti-social behavior that was a precursor to developing psychopathy as an adult.

The researchers attempted to examine whether these callous traits were truly psychopathy — or if they were caused by something else. Interestingly, they found that many of these adolescents actually didn’t fit in the definition of psychopathy. They used a more robust psychological test than is typically used to identify psychopathy, which allowed for them to examine a wider range of personality and emotional traits.

“They appear callous and unemotional to others but are actually very distressed, have high levels of anxiety, higher levels of depression, higher levels of emotion,” Tim Stickle, professor of psychology at the University of Vermont and author of the study, said in the press release. “We think of these harmful, antisocial, aggressive kids as being immune to fear, immune to negative feelings, but in fact we’re showing a whole group of them are not only not immune, but are very susceptible.”

Stickle notes that the findings suggest that instead of lumping these kids into the psychopathic classification, they can actually be treated properly with cognitive behavioral therapy that could help them manage emotions. “There is an opportunity to do things differently and more effectively,” he said. “Untreated callous unemotional traits put these youth at risk for becoming lifelong criminals.”

Thus, the researchers argue, using this more effective personality test could allow for a better chance to identify whether adolescents are truly psychopathic, or simply suffering from emotional distress.

“It’s not just one characteristic that allows clear identification of who falls in which group; it takes a wide range of traits,” Stickle noted. “Using a wide range of measures of emotional experience and expression is very important to clearly identify who these individuals are so they can be helped.”

Source: Gill A, Stickle T. “Affective Differences Between Psychopathy Variants and Genders in Adjudicated Youth.” Journal of Abnormal Child Psychology. 2015.