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Fantasy and imagination play an integral role in childhood social and neural development, and to some extent serve a person's interests across the life course, inspiring everything from research and innovation to the creation and cultivation of art and culture. However, fantasy run amuck—and sustaining an overactive imagination into adulthood—has been identified as the prime meridian from which numerous forms of deviance and delinquency stem; this includes the lying acumen and aptitude for deception necessary for a classification of psychopathy.

While a formal clinical or medical diagnosis of psychopathy cannot officially be made, it is a general classification often included in, or found to accompany, any number of contemporaneous personality or mental disorders. Most frequently, these disorders include elements of psychopathy such as antisocial personality disorder and narcissistic personality disorder, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Psychopathy, which frequently includes these or other underlying disorders, is then generally characterized by conning, manipulative, and egocentric behavior, and is most frequently associated with predatory offenses of a compulsive or cyclical nature that reinforce an offender's need for control, including serial homicide and serial rape.

Building on this typology, Canadian psychologist Dr. Robert Hare, in developing his Hare psychopath checklist, revised (PCL-R), established a menu of 20 characteristics traversing four behavioral facets, from which a numerical score could be used to classify a subject as fitting within a spectrum of psychopathy. With a maximum score of 40, the PCL-R examines key personality traits and lifestyle patterns for evidence of psychopathy, and in theory, enables the forecasting of criminal activity based on the tabulated results. As a type of Myers-Briggs test for deviants, the PCL-R was developed from American psychologist Hervey Cleckley's Cleckley checklist, an index of 16 common characteristics of psychopaths, first published in 1941. Since the 1990s, however, Hare's checklist has prevailed as the leading method used for assessing psychopathy in institutional settings, such as prisons and psychiatric facilities.

Both the Cleckley and Hare checklists include, among other traits such as criminal versatility and habitual lying, categories specifically relating to grandiose self-imagery and being consumed by unrealistic, adolescent fantasies of power or control at the expense of realistic long-term goals. Further research, including interviews with criminal psychopaths studied during the development of the FBI's Mind Hunter Program (now the Behavioral Science Unit) that was developed during the 1980s by nascent profilers applying Cleckley and Hare's methods, as well as new academics working in what was fast becoming an interdisciplinary area, identified the development of and preoccupation with fantasy as the tipping point that turned conventional psychopaths into violent serial predators. It was determined—using case studies like Ted Bundy, who convincingly camouflaged his sadistic and murderous tendencies with a manufactured exterior persona—that lying and fantasy were mutually inclusive in the case of the most well-developed, and by extension the most dangerous, psychopaths.

While control-based fantasies need not always be accompanied by psychopathic behavior, nearly all cases of psychopathy involve some cultivation of fantasy or imagined relationships to people or places that eventually lead to harm. Lying and rehearsed deception are in turn the means by which the psychopath develops a social mask, and the means by which they conceal the dangerous nature of their fantasies and need to exert control and humiliate others. This explains in part why psychopaths make poor candidates for polygraph examinations, in that their baseline stress responses to lying are negligible, or in some cases are altogether absent because lying becomes a routine activity and a necessary mechanism to sustain their duplicitous identity.

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