If present in females, it usually occurs at the onset of puberty. In males the onset is usually earlier on in childhood. Behaviors can diminish somewhat after the age of thirty when the individual seems to mellow out and learns more effective ways of staying within the system. Clients tend to be very manipulative and lack motivation for change. They very rarely seek therapy voluntarily and they are usually forced into therapy through some involvement with the law or other aspects of their life.
History also reveals significant impairment in social, marital, and occupational functioning.
Therapists relate that these clients tend to lack emotional attachment to others. They tend to be personable, charming, and engaging and are usually above average in intelligence. This demeanor, however, is often a pretense intended to deceive others and facilitate the exploitation of others. Emotional reactions tend to be extreme and these individuals tend to lack concern for other people s feelings, be preoccupied with their own interests, and tend to have grandiose expressions of their own importance. Insight and judgment are usually poor as is their responsiveness to therapy.