Personal Information
Name: ___________________________
Phone: ___________________________
Rating Scale
Each item is rated using the following scale:
- 2 – Definitely Present
- 1 – Possibly Present
- 0 – Definitely Absent
Checklist Items
Section 1
- Glibness / Superficial Charm
- Previous Diagnosis as Psychopath (or Similar)
- Egocentricity / Grandiose Sense of Self-Worth
- Proneness to Boredom / Low Frustration Tolerance
- Pathological Lying and Deception
- Conning / Lack of Sincerity
- Lack of Remorse or Guilt
- Lack of Affect and Emotional Depth
- Callous or Lack of Empathy
- Parasitic Lifestyle
- Short-Tempered / Poor Behavioral Controls
Section 2
- Promiscuous Sexual Relations
- Early Behavior Problems
- Lack of Realistic, Long-Term Plans
- Impulsivity
- Irresponsible Behavior as a Parent
- Frequent Marital Relationships
- Juvenile Delinquency
- Poor Probation or Parole Risk
- Failure to Accept Responsibility for Own Actions
- Many Types of Offense
- Drug or Alcohol Abuse Not Direct Cause of Antisocial Behavior
Scoring System
- Definitely Present = 2 points
- Possibly Present = 1 point
- Definitely Absent = 0 points
Total Score: __________
Score Interpretation
0–8 Points
Not Present
If the trait or behavior described is not evident in the individual being assessed. This means that the characteristic is not a notable aspect of their personality or behavior.
9–15 Points
Partial or Limited
Given that there is a partial match or a limited degree of the trait or behavior. The characteristic is present to some extent but is not a dominant or defining feature of the individual’s personality.
16–22 Points
Present
A score in this range indicates that the traits or behaviors are strongly present. These characteristics are notable and consistent aspects of the individual’s personality or behavior.
Additional Information (From Original Document)
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