The objective of this study is to present a theoretical paper about a clinical issue. Our aim is to propose some clinical and semiological considerations for a psychopathological conception of psychopathy. We will discuss several major theoretical works dedicated to this nosographic entity (mainly those of Schneider [Psychopathic Personalities (1923). London, Cassell, 1950], Cleckley [The Mask of Sanity. St. Louis, Mosby, 1941] and Hare [The Hare Psychopathy Checklist Revised Manual, ed 2. Toronto, Multi-Health Systems, 2003]). We will also examine a significant issue raised by Cooke et al. [Psychol Assess 2001; 13: 171-188; J Person Disord 2004; 18: 337-357; Br J Psychiatry Suppl 2007; 49: s39-s50; Int J Forensic Ment Health 2012; 11: 242-252], namely whether psychopathic functioning is consistently related to antisocial behavior. This theoretical essay is informed by clinical situations (involving psychopaths who were interviewed in prison or in forensic centers). The method applied a phenomenological psychopathology analysis to the clinical material. We first compare Binswanger's conception of mania with psychopathic functioning. Patient behavior is similar, but there is a difference related to the dialectic between the ego and the alter ego. A patient with mania has a fundamental crisis of the ego, which a psychopath does not have. A second finding of our investigations concerns emotions and the adaptive dimension of the psychopathic disorder. An epistemological discussion of the concept of emotions reveals that psychopaths are competent in the management of emotional stimuli, which confers a psychological advantage upon them. (C) 2015 S. Karger AG, Basel