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Psychopath vs. Sociopath: Two Varieties of Antisocial Personality

Many people use the terms “psychopath” and “sociopath” interchangeably. They are most often used about someone that is considered to be without a conscience. The societal definitions revolve around one’s approach to violence, anger, hatred, and emotionlessness. Both of these terms are bandied about on detective shows and true crime podcasts, but what do they actually mean? 

The truth is, there still aren’t hard and fast definitions for either term. Indeed, they are sometimes (though decreasingly) used interchangeably. This article explores what seem to be the most common understandings of psychopathy and sociopathy within the mental health field. 

First, We Must Understand Antisocial Personality 

It’s important to note from the outset that both psychopathy and sociopathy are controversial ideas in the world of psychology. Neither appears in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) as a diagnosis. However, it does mention that both “psychopath” and “sociopath” are terms used to describe people who are diagnosed with Anti-Social Personality Disorder (ASPD). Dr. Donald W. Black describes ASPD as “defined by a pattern of socially irresponsible, exploitative, and guiltless behaviour. Symptoms include failure to conform to law, failure to sustain consistent employment, manipulation of others for personal gain, deception of others, and failure to develop stable interpersonal relationships.” Many consider psychopathy and sociopathy to be two different varieties of ASPD.  Consider ASPD the “big bucket” term, like pink, and psychopathy and sociopathy as smaller buckets, like fuchsia, rose, and pastel pink.

What Is a Psychopath?

A psychopath is someone with ASPD who behaves in an amoral and antisocial way, lacks the capacity to love others or establish meaningful relationships in their personal life, demonstrates a remarkably self-centered perspective (i.e., extreme egocentrism), and doesn’t learn lessons from experience. It’s believed that psychopathy is detectable through brain scans—in fact, there is a fascinating case about a brilliant neuroscientist who discovered he had the brain of a psychopath by accident. 

Characteristics of a Psychopath

What Is a Sociopath?

“Sociopath” describes someone with ASPD who has a pattern of antisocial behaviors and attitudes such as manipulation, deceit, aggression, and lack of empathy for others.

Characteristics of a Sociopath

Psychopath vs. Sociopath: Key Contrasts

Given that sociopathy and psychopathy are both subsets of Antisocial Personality Disorder, it’s unsurprising that there’s quite a bit of overlap between psychopaths and sociopaths. However, there are some key differences. 

ASPD and Violence

When most of us think about psychopaths and sociopaths, our first thought isn’t the high-powered executive or the brilliant doctor; it’s the serial killers of the world. The most common misconception about both psychopaths and sociopaths is that they are inherently violent. Many people with ASPD who might be described as psychopathic or sociopathic never harm others or act violently. Nevertheless, some of the most violent people in history did have ASPD.

Where Do Narcissists Fit in?

Narcissistic Personality Disorder (NPD) is an entirely different diagnosis that is often confused by the general public with ASPD, especially with sociopathy. According to the DSM-V, narcissists have a sense of entitlement, arrogance, and self-importance; consider themselves special; take advantage of others; need admiration; lack empathy; and are obsessed with the fantasies of boundless power. While there is some overlap between ASPD and NPD, and an individual can be diagnosed with both, there are some fundamental differences between these diagnoses. 

Treatment and Outcomes

Personality disorders are not curable. However, there is a wide variety of outcomes for people with this diagnosis. Treating ASPD is difficult but valuable. People with ASPD can tend toward illegal or risky behavior, but many don’t take this path and have very successful professional lives. 

As with many other mental health concerns, ASPD is often accompanied by co-occurring disorders, such as depression and substance abuse. It’s important for the antisocial person to pursue treatment for any co-occurring disorders they may have. 

While there isn’t yet a “gold standard” treatment for those with ASPD, studies seem to indicate that psychotherapy (i.e., “talk therapy”) can yield behavioral results, particularly when it comes to criminal recidivism. Research is ongoing into the effectiveness of treating antisocial persons in a variety of ways. 

When You Know Someone Who May Have ASPD

Show Support

If you know someone who may have ASPD, remember that they may not be aware of it. Either way, it is important to show support if you’re part of their life. 

Keep Healthy Boundaries

Since people with ASPD are often prone to manipulation, it’s best for you and them if you establish boundaries in your relationship that will keep you both safe from toxicity. Remember that your character is about you—for example, if kindness is an important value to you, keep being kind, even if you can’t “be nice” all the time. Boundaries will help you be your best self in all your relationships, including (and maybe especially) this one. 

Encourage Them to Seek Treatment

The most important thing a person can do to help someone with ASPD is to encourage them to seek professional help. If you or someone you know might have ASPD, rest assured that there are mental health providers who have been trained to help. 

Room for Hope

Getting an Antisocial Personality diagnosis can be scary, but you can find support and help. Generalities—including diagnoses—can be helpful, but they can also feel like life sentences. Don’t let your diagnosis define you; it’s meant to be a tool to help you and others understand the way you’re wired. While the “typical” person with ASPD probably wouldn’t reach out for help, you don’t have to fit that mold. There is always hope for growth.

Click through to find a therapist in your area who can support you or a friend through personality disorder treatment.

References

Black, D. W. (2015). The natural history of antisocial personality disorder. The Canadian Journal of Psychiatry, 60(7), 309-314. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500180

Robinson, K. M. (2014, August 24). Sociopath vs. psychopath: What’s the difference? Retrieved from http://www.webmd.com/mental-health/features/sociopath-psychopath-difference#1

Wilson, H. A. (2014, March 5). Can antisocial personality disorder be treated? A meta-analysis examining the effectiveness of treatment in reducing recidivism for individuals diagnosed with ASPD. International Journal of Forensic Mental Health, 13(1), 36-46. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/14999013.2014.890682?journalCode=ufmh20

A woman's eyes reflected in her rear view mirror while drivingAntisocial personality (ASPD) is one of the cluster B personality disorders, which typically involve emotional, impulsive, or dramatic thoughts and actions. This group of personality disorders is also significant because it includes borderline personality disorder (BPD) and narcissistic personality disorder, in addition to ASPD. These issues, and personality disorders in general, are among the most stigmatized mental health conditions.

Colloquially, many people use the terms psychopath and sociopath interchangeably with antisocial personality. A common assumption is that all people who have ASPD are incapable of emotion and feeling and will eventually commit violent crimes and harm others. It’s true many people living with ASPD typically don’t feel remorse or guilt. They may also lack empathy, struggle to understand the emotions of other people, or experience frequent legal issues, due to a tendency toward impulsive and often dangerous or illegal actions.

But sociopathy isn’t a mental health diagnosis, and not every person with ASPD will hurt other people or engage in violent acts. It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist. In therapy, people can develop interpersonal skills along with coping techniques for impulsivity and aggression. These tools can benefit people who want to improve relationships and avoid illegal or dangerous activities and behaviors that harm others.

It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist.

How Common Is ASPD?

The estimated prevalence of ASPD may vary depending on the study and criteria used. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), between around 0.2 and 3.3% of the population has ASPD in a given 12-month period. This condition is only diagnosed in people over the age of 18.

More than 90% of people diagnosed with ASPD also live with another mental health issue. Substance abuse is the most common co-occurring condition. Research suggests ASPD occurs much more frequently in men diagnosed with alcohol use disorder. Higher prevalence is also seen in prison settings, as well as population samples from impoverished areas. Other common co-occurring issues are anxiety and depression.

Though ASPD is far less common in women than it is in men, some research has suggested when ASPD develops in women, the condition may become more severe. Women living with ASPD are even more likely to abuse substances than men living with ASPD. However, research also indicates antisocial behavior may persist longer in men. Men who have ASPD also have an increased risk of early death.

Aggressive and violent behavior in childhood, such as that seen with conduct disorder, can be an indicator for ASPD. Not all children who have conduct disorder will go on to develop ASPD, but a history of conduct disorder is one of the diagnostic criteria for ASPD. These symptoms must appear before the age of 15. Parental neglect, abuse, or inconsistency and a lack of stability from primary caregivers can all increase the risk that a child with conduct disorder will develop ASPD.

Asocial vs Antisocial

It’s not uncommon to hear antisocial used to refer to people who prefer to be on their own and avoid spending a lot of time with others. But “asocial” is a more accurate way to define this lack of interest in social interaction. Asocial can describe a general disinterest in society and engagement with others, but it doesn’t indicate a person harbors any ill will or negative intent toward others.

Antisocial, on the other hand, goes beyond a general dislike or avoidance of society and community. People who meet criteria for a diagnosis of ASPD typically feel hostile toward other people. Even those who don’t have actively hostile feelings toward others may care very little for the safety, general well-being, and feelings of most other people. It’s also not uncommon for people who have antisocial traits to have significant disregard for their own safety.

It’s important to note that these feelings don’t necessarily translate to violent tendencies. Studies of people in prison do reveal high rates of ASPD, but this condition occurs on a spectrum, and not everyone living with the condition becomes violent or dangerous. Research has also observed that some people who display antisocial traits may have developed these behaviors in order to survive and protect themselves when growing up in difficult circumstances.

Many people use psychopathy as a synonym for ASPD, but this usage isn’t accurate. Psychopathy can best be considered a severe form of ASPD, rather than the most characteristic presentation of the condition. Most people who meet criteria for psychopathy according to the Psychopathy Checklist – Revised (PCL – R) do also meet criteria for ASPD. But only about 10% of people diagnosed with ASPD also meet criteria for psychopathy.

What Is Antisocial Personality Disorder?

At the core of ASPD lies a consistent lack of regard for the rights of others, which generally includes impulsive, irresponsible, and reckless behavior. People may take action without considering potential consequences and experience little or no remorse for harm caused by their behavior. Theft, manipulation, and other deceit are common, and people living with ASPD also tend to rationalize or minimize their actions.

Antisocial behavior can include violent or criminal acts, but people living with ASPD aren’t always aggressive or violent. Similarly, while many people with ASPD lack empathy, this isn’t always the case. People living with ASPD often struggle to develop or maintain meaningful relationships, and they may cause emotional harm to their partners; but it’s still possible for people with ASPD to feel love and empathy, often for a select few people such as children, partners, or close family members.

Abuse, neglect, or absent caregivers can increase risk for ASPD when other factors are present, particularly early onset conduct disorder. In people who develop ASPD, early childhood mistreatment can reinforce the belief that no one else will look out for them, so they should do whatever they can to look after themselves and get their needs met. This belief commonly occurs with ASPD.

In recent years, a few people with ASPD have written about their experience living with the condition. This may have had a small effect on the stigma surrounding the condition, but many people still struggle to accept that ASPD doesn’t always mean a person is violent or “evil.” The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. Negative attitudes from caregivers and educators may begin early on, often when children first display signs of conduct disorder.

The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need.One study of 202 kindergarten teachers found teachers were most likely to have a harsh response toward aggressive children. But negative attitudes, or writing children off as troublemakers or delinquents, can reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” from early childhood. Some experts believe this can increase the chances aggressive behavior and disregard for others will continue and worsen.

Treatment for Antisocial Personality Disorder

Not everyone considers ASPD a mental health issue. Research has shown that many people believe people with this condition are:

Having a mental health issue doesn’t absolve a person of responsibility for their actions, but it’s an important factor in understanding why some people behave the way they do. When stigma perpetuates the idea of a group of people as evil, positive change becomes even more difficult to achieve.

Specific characteristics associated with ASPD, such as self-sufficiency, a tendency to externalize problems, disdain for authority, and general hostility, also make it less likely people with ASPD will ever reach out for help, complicating treatment and decreasing the chance of improvement.

When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition or because a legal authority or family member has steered them toward therapy. Among those who do get help, many drop out of treatment early. Negative attitudes among therapists or ineffective treatment methods can contribute to this.

It’s important for people with ASPD to work with therapists who offer compassionate support and are willing to try a range of approaches to find the most effective treatment. In many cases, people with antisocial traits can learn skills to cope with their condition and avoid acting in ways that negatively affect others. When people with a dual diagnosis seek treatment, it’s essential for therapists to recognize the ways ASPD can contribute to and worsen other mental health symptoms.

A key factor in successful therapy for ASPD is recognizing individual fault. People living with ASPD who can’t admit or accept their actions are harmful or that they have a role in the harm they’ve caused may not be able to improve. One approach to treatment that’s shown some promise is mentalization-based therapy. This approach helps people explore their state of mind, including emotions, desires, and feelings toward others. Once they better understand their thoughts, they can use this understanding to address impulses and control them.

Some research suggests schema therapy, an approach that helps people work to identify and address maladaptive behavior patterns and develop more effective ways of relating, may also be helpful for people with ASPD. It’s effective for other personality disorders, including BPD and narcissistic personality, and some research suggests people are less likely to drop out of this type of therapy than other approaches.

Research has shown treatment can help improve many of the behaviors associated with ASPD when a person is willing to work toward change. It’s important for future research to continue exploring the most helpful types of treatment for ASPD to increase the chances of people with the condition improving with treatment. Successful treatment can not only improve well-being and quality of life for people with ASPD, it can also have a positive impact on the people in their lives.

If you or a loved one is struggling with the effects of ASPD, know that help is available. Begin your search for a trained, compassionate counselor at GoodTherapy.

References:

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
  2. Antisocial personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder
  3. Antisocial personality disorder. (2018, May 25). NHS. Retrieved from https://www.nhs.uk/conditions/antisocial-personality-disorder
  4. Arbeau, K. A., & Coplan, R. J. (2007). Kindergarten teachers’ beliefs and responses to hypothetical prosocial, asocial, and antisocial children. Merrill-Palmer Quarterly, 53(2), 291-318. doi: 10.1353/mpq.2007.0007
  5. Brians, P. (2016, May 17). Asocial. Retrieved from https://brians.wsu.edu/2016/05/17/asocial
  6. Brill, A. (2017, June 16). Life with antisocial personality disorder (ASPD). Retrieved from https://www.mind.org.uk/information-support/your-stories/life-with-antisocial-personality-disorder-aspd/#.XMY0wJNKjOT
  7. British Psychological Society. (2010). Antisocial personality disorder: Treatment, management, and prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK55333
  8. Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BMC Medicine, 8, 66. doi: 10.1186/1741-7015-8-66
  9. Mayo Clinic Staff. (2017, August 4). Antisocial personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/drc-20353934
  10. Sheehan, L., Nieweglowski, K., & Corrigan, P. (2016, January 16). The stigma of personality disorders. Current Psychiatry Reports, 18, 11. doi: 10.1007/s11920-015-0654-1

Black and white photo of blurred reflections of passersby “Narcissism.” This word is tossed around easily these days. Because people hear it so often, they tend to think they know what it means. This is often what happens when a clinical term enters the vernacular. But take a minute. What is your understanding of the word? Now ask three others the same question. I will bet you end up with four different answers.

Think about conversational use of “psychopath,” “sociopath,” “bipolar“, “OCD“, or “autistic,” to mention a few more. Two of those words have no clinical meaning at all, and the others are not likely to be understood accurately by anyone outside the health professions. Again, definitions likely vary from person to person.

So why is their use so pervasive?

To use a word is to align with a group that agrees tacitly upon its definition: to join the group of people who believe they understand the innuendo of its colloquial usage. You call someone a psychopath, for example, and you believe that others are likely to think you at least mean the person acts without regard to the welfare of others, often in a criminal manner. That’s just a sliver of the actual components of antisocial personality, the real clinical term that describes what people think they are saying with “psychopath,” but no matter. The word “psychopath” is unlikely to fall from the American lexicon anytime soon. The same goes for the slippery common usage of the other terms mentioned above.

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It is also a way to use shorthand to describe more complex thoughts. Speaking in buzz words such as “psychopath” or “narcissist” is to speak with semaphores, abstractions. You assume meaning is implied. Remember, for example, that people visualize different shades of color when you say “red” or “blue.” That’s why we say “crimson,” “scarlet,” “vermillion,” “azure,” “cerulean,” or “sky.” We try to be specific when we describe color in order to communicate accurately. Why not be as specific as possible when describing your own reactions?

Another possible reason for using terms like these is because it might seem more educated to call someone a psychopath rather than a thoughtless and selfish bully. If you really understand something well, however, you are able to explain it to a child. Using impressive words sometimes masks insecurities, and it can also be an unconscious attempt to deflect attention from otherwise vague understanding.

It is not just the language of mental health that gets eviscerated and co-opted in this manner. People often claim that something begs the question, for example, which is a term borrowed from formal logic. (To “beg the question” means to “assume something you’re trying to prove,” instead of proving it. It doesn’t mean forcing the question.)

People say someone is “libel” when they mean responsible, which no doubt makes lawyers cringe. And you hear climate change disparaged as “just a theory,” a dismissal that demonstrates a miscomprehension of the scientific method.

It is difficult to look at any news source without stumbling upon a discussion of the supposed narcissism of Donald Trump. Is it inaccurate to use this word when talking about the Republican candidate for presidency of the United States? His behavior suggests there is a reason the word “narcissist” seems to be everywhere these days. I suggest there are better, more specific words that would describe it with undeniable precision. No diagnosis is required to speak about him in meaningful terms.

When you hear Trump speak, what do you feel? What do you think? When you watch his posture and gestures, what is your reaction? What thoughts does his presentation evoke from you? This is interesting stuff. This is what your friends want to know about you. By providing it, you give them permission to go deeper in their own comments and articulate their own personal responses with greater discernment.

Anyone can apply insight to watching Donald Trump and describe his manner, behavior, and persistent views with knife-like accuracy. Borrowing clinical terms actually dilutes this accuracy. Go for articulating your opinion in your own meaningful language instead.

The Goldwater rule is the colloquial name of an aspect of medical ethics that the American Psychiatric Association developed after certain psychiatrists put forward their purported psychological evaluations of Barry Goldwater, the Republican candidate for the presidency in 1964. These psychiatrists claimed that because of his mental status, he was not fit to be president. He sued for libel and won.

APA ethics have since required diagnoses to be made only when someone is a patient or client, rather than based upon observations of someone in the public eye. This makes many mental health professionals duly wary about making public declarations.

It is certainly worth examining our daily language for hollow words such as “narcissist.” For example, is it really so bad to say “selfish”? Or to describe the way a person’s behavior hurt you or damaged someone else? Speaking your own truth is more powerful than any borrowed term could ever be.

It is clear that times have changed since 1964, when America had three television channels. Today, we have access to so much information about public figures that it is possible to get a profound sense of who a person is without actually having met. In fact, with the current Republican candidate for president, it is likely that mental health professionals know more about him than they know about the interactions and lives of some of the people they meet with in their offices.

So what does this mean with regard to the term “narcissism”?

First of all, there really is a clinical diagnosis called narcissistic personality disorder. Like the other personality issues, it is descriptive of pervasively distressing characteristics which impede an individual’s ability to live a fulfilling and healthy life. Such a diagnosis can be devastating, whether accepted by an individual or denied. It is a difficult path to change. Emotional wreckage lies in the wake of such persons over the course of their lives.

For clinicians who wonder about Trump, for example, there is no shortage of conversation among peers. There is plenty of material to discuss. Whether the APA Goldwater rule should be reviewed seems a fair question, considering so much accurate personal information is available. We can watch people we don’t know personally speak and interact in public. Still, most mental health professionals remain reticent about going public with their thoughts on this subject.

It is certainly worth examining our daily language for hollow words such as “narcissist.” For example, is it really so bad to say “selfish“? Or to describe the way a person’s behavior hurt you or damaged someone else? Speaking your own truth is more powerful than any borrowed term could ever be. Also, your well-considered personal statements convey more information than a word that each person is likely to interpret in a different way. The more code words, such as “narcissist,” we add to our speech, the less likely we are to be fully understood.

The mitigating fact for psychotherapists and other mental health professionals is always this: we can never truly know all that goes on inside the mind and life of another person. We study and train for years and then pass licensure examinations in order to have the privilege of offering what we hope are helpful observations to the people who come to us for help. Good psychotherapists live in deep humility, aware of the great gift of trust placed in them by people in distress.

If we refrain from making cavalier diagnoses, might it not be prudent also for nonprofessionals to consider doing the same? And if the goal of communication is to convey thoughts and feelings and observations to another person as fully as possible, why not go for the accuracy that your own personal vocabulary is able to provide? Describe. Explain. No diagnostic language is necessary. Most people would better understand your own definition of bullying and your views about a person who bullies than they would your description of the same person as “narcissistic.”

Important Notice

GoodTherapy is not intended to be a substitute for professional advice, diagnosis, medical treatment, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptom or medical condition. Never disregard professional psychological or medical advice nor delay in seeking professional advice or treatment because of something you have read on GoodTherapy.