The character Hannibal "the Cannibal" Lecter, best known from the motion picture The Silence of the Lambs from 1991, has become a cultural icon and model for later portrayals of seriously disturbed offenders. He displays key characteristics of the Psychopathy ChecklistRevised, such as arrogance, manipulation, callousness, and lack of remorse. From a clinical point of view, one of the most fascinating aspects with Lecter is his display of a variety of capacities alternating between cold-blooded predatory behavior, affection toward FBI special agent Starling, and mourning of the loss of his sister Mischa. Many authors have described the ruthless characteristics of the psychopath. Through the lens of object relations theory, this review systematically examines case descriptions of severely psychopathic offenders published between 1980 and March 2009. In contrast to the prevalent opinion, case material (n = 11) demonstrates that severely psychopathic offenders do suffer from psychological pain. (Published Abstract)