Psychopathy, while not a clinical diagnosis, often refers to someone with antisocial personality disorder.
Few psychology terms stir up confusion like “psychopath.” Even though it’s commonly (though incorrectly) used to describe someone who has a mental health condition, “psychopath” is not an official diagnosis. Instead, it’s an informal term often used for a condition called antisocial personality disorder (ASPD).
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not list psychopathy as an official clinical diagnosis.
The true definition of a psychopath in psychiatry refers to someone with ASPD, explains Dr. Prakash Masand, a psychiatrist and co-founder of the Centers of Psychiatric Excellence. ASPD describes a condition marked by patterns of manipulation tactics and violation of others.
Masand says one thing that can be confusing about ASPD is the phrase “antisocial.”
“Most people might assume this describes someone who is reserved, a loner, keeps to himself, etc. However, this is not the case in ASPD,” he explains. “When we say antisocial in ASPD, it means someone who goes against society, rules, and other behaviors that are more commonplace.”
While some clinicians regard psychopathy as a more severe subtype of ASPD, the general consensus is that psychopathy falls under the umbrella of ASPD. In this article, we refer to information about ASPD.
Read on to learn more important information about ASPD, such as the signs, diagnostic criteria, and treatment options.
Signs of psychopathy
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Illustration by Sophia Smith
Since the term “psychopath” is not an official diagnosis, experts refer to the signs described under ASPD. According to Masand, some of the more common signs of ASPD can include:
- behavior that conflicts with social norms
- disregarding or violating the rights of others
- inability to distinguish between right and wrong
- difficulty with showing remorse or empathy
- tendency to lie often
- manipulating and hurting others
- recurring problems with the law
- general disregard toward safety and responsibility
- expressing anger and arrogance on a regular basis
Other possible signs of ASPD include a tendency to engage in behavior that’s reckless, impulsive, or may lead to harmful consequences.
Masand says someone exhibiting this behavior may also:
- lack deep emotional connections
- have a superficial charm about them
- be very aggressive
- get very angry sometimes
Additionally, people with ASPD may not react as if they have hurt someone, and they may be impulsive or abusive and may lack remorse. In the case of ASPD, abusive doesn’t necessarily mean violent.
In addition to the signs and behaviors, Masand says there are certain characteristics that are more prevalent in people with ASPD:
- ASPD is more common in men than women.
- Technically, to receive an ASPD diagnosis, you have to be at least 18 years old. But some children will show signs of conduct disorder, which may be an early indicator of ASPD.
- ASPD is a chronic (long-term) condition that seems to improve with age, and remittance (no longer showing signs of antisocial behavior) is possible.
- Mortality rates are higher in people with ASPD because of their behavior patterns.
Since psychopathy is not an official mental health condition, the condition experts diagnose is ASPD. This is one of four cluster B personality disorders outlined by the DSM-5, and the other three are:
- borderline personality disorder (BPD)
- histrionic personality disorder (HPD)
- narcissistic personality disorder (NPD)
Before explaining the criteria used to diagnose ASPD, it’s important to mention that diagnosing and treating ASPD presents some unique challenges.
According to Masand, ASPD can be difficult to treat because the person who needs help often doesn’t believe there is a problem with their behavior. As a result, they rarely seek treatment.
That said, according to the established guidelines used to diagnose ASPD, the behavior generally begins by age 15 or in the teenage years. However, Masand says a true ASPD diagnosis is not made until the age of 18.
“For most people, the worst of the behavior occurs in the late teen years throughout the twenties,” he explains.
To get a proper diagnosis, a mental health professional will conduct a full mental health evaluation. During this process, the mental health professional will evaluate a person’s:
- behavior patterns
The mental health professional will identify symptoms and compare them with the ASPD criteria in the DSM-5.
In order to receive a diagnosis of ASPD, a person must show a pattern of disregard for and violation of the rights of others. This is indicated by three or more of the following criteria, according to the DSM-5:
- failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest
- deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit
- impulsivity or failure to plan
- irritability and aggressiveness, often with physical fights or assaults
- reckless disregard for the safety of self or others
- consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations
- lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person
The mental health professional will also look at a person’s medical history. This full evaluation is a critical step since people with ASPD often have other mental health and substance use disorders.
Because a true ASPD diagnosis is typically delayed until the age of 18, adolescents and teens who display similar symptoms are often evaluated for conduct disorder (CD) or oppositional defiant disorder (ODD).
Of the two behavior disorders, CD is more severe than ODD.
When determining if a child has ODD, mental health professionals will look at how they act around people they know. Typically, someone with ODD is more likely to act oppositional or defiant around family members, teachers, or a healthcare professional.
If an adolescent or teen shows an ongoing pattern of aggression toward others and regularly makes choices in opposition to the rules and social norms at home, at school, or with peers, a clinician may decide to evaluate for CD.
To receive a diagnosis of ASPD before the age of 18, a teen must also have a previous diagnosis of CD by age 15.
Psychopath vs. sociopath
“Psychopath” and “sociopath” are often used interchangeably to informally describe someone with ASPD. Since sociopath is also not an official diagnosis, it typically joins psychopath under the umbrella diagnosis of ASPD. There is no clinical difference between the two terms.
Both psychopathy and sociopathy are other terms or ways to describe ASPD. The behaviors that are often seen in both tend to fall under the criteria of ASPD.
Can you treat psychopathy?
Like the diagnostic process, treating someone with traits that fall under the ASPD diagnosis can be difficult. Typically, a doctor may recommend a combination of psychotherapy (talk therapy) and medication.
While no evidence supports that any medication or form of psychotherapy can cure ASPD, these methods may still help manage some of the symptoms, like impulsivity and aggression, and improve quality of life.
According to a 2015 review, early interventions in adolescents and teens who received a diagnosis of CD may also help prevent ASPD.
The researchers in the 2015 review also found that for some people with ASPD, the condition may improve or remit as they get older — with improvement occurring at a median age of 35. They also found that people with stronger social ties and support, such as a spouse or family, were more likely to experience remission.
Psychotherapy may be helpful in understanding how the disorder can impact your life and relationships. A mental health professional will work to develop strategies that help decrease the severity of the symptoms.
If medication is part of the treatment plan, a doctor might prescribe medications that treat related mental health conditions, such as anxiety, depression, or symptoms of aggression.
Options may include:
- antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or bupropion
The word “psychopath” is often informally used to describe someone with ASPD.
ASPD is notthe same as being “antisocial.” It primarily involves behavior that conflicts with social norms, as well as a general lack of disregard for others.
Despite the complexities surrounding ASPD, a mental health professional may be able to identify this condition and offer treatment that can help.
Read this article in Spanish.
Sociopath is a term people use, often arbitrarily, to describe someone who is apparently without conscience, hateful, or hate-worthy. The term psychopath is used to convey a sociopath who is simply more dangerous, like a mass murderer.
Although sociopath and psychopath are often used interchangeably and may overlap, each has its own clear lines of distinction. For example, sociopathy is the unofficial term for antisocial personality disorder (APD), while psychopathy is not an official diagnosis and is not considered an APD.
Click Play to Learn the Difference Between Psychopaths and Sociopaths
This video has been medically reviewed by Rachel Goldman, PhD, FTOS.
Differences Between Sociopath vs. Psychopath
Psychopaths are classified as people with little or no conscience but are able to follow social conventions when it suits their needs. Sociopaths have a limited, albeit weak, ability to feel empathy and remorse. They’re also more likely to fly off the handle and react violently when confronted by the consequences of their actions.
Make it clear they do not care how others feels
Behave in hot-headed and impulsive ways
Prone to fits of anger and rage
Recognize what they are doing but rationalize their behavior
Cannot maintain a regular work and family life
Can form emotional attachments, but it is difficult
Pretend to care
Display cold-hearted behavior
Fail to recognize other people’s distress
Have relationships that are shallow and fake
Maintain a normal life as a cover for criminal activity
Fail to form genuine emotional attachments
May love people in their own way
Willem H.J. Martens argues in his infamous article “The Hidden Suffering of the Psychopath” that psychopaths do at times suffer from emotional pain and loneliness. Most have lead hurt-filled lives and have an inability to trust people, but like every human being on the planet, they, too, want to be loved and accepted.
However, their own behavior makes this extremely difficult, if not impossible, and most are aware of this. Some feel saddened by the actions they are unable to control because they know it isolates them from others even more.
Approach to Violence
While it’s common to think of sociopaths and psychopaths as being inherently dangerous, this is more a construct of a TV drama than a true reflection of the disorder. Violence, while certainly possible, is not an inherent characteristic of either sociopathy or psychopathy.
With that being said, people with APD will often go to extraordinary lengths to manipulate others, whether it be to charm, disarm, or frighten them, in order to get what they want. When psychopaths do become violent, as in the case of Jeffrey Dahmer, they’re just as likely to hurt themselves as others.
Martens notes that the more a psychopath feels socially isolated, sad, and alone, the higher his or her risk for violence and impulsive and/or reckless behavior.
Origins and Development
There are some who say that “sociopaths are made and psychopaths are born,” but this characterization may be too far broad. Although it is true that psychopathy is believed to have genetic components (perhaps caused by the underdevelopment of the parts of the brain that regulate emotion and impulsiveness), there are clearly other factors that contribute to the behavioral disorder.
A well-regarded study into psychopathy suggested that psychopaths often have a history of an unstable family life and/or were raised in poorer neighborhoods prone to violence. Many have had parents who were substance abusers and who failed to provide parental guidance or attention.
This typically translates to unstable and failed relationships in adulthood and a fixated sense that you have been “robbed” of opportunities and advantages afforded to everyone else. Sociopathy also tends to be associated with harmful childhood experiences, including sexual abuse, physical violence, or parental instability.
Sociopaths have a conscience, albeit a weak one, and will often justify something they know to be wrong. By contrast, psychopaths will believe that their actions are justified and feel no remorse for any harm done.
This differentiation may suggest that nature plays more of a role in the creation of a psychopath than a sociopath. This is supported in part by a 2014 review of studies in which as many as a third of people diagnosed with sociopathy essentially “give up” their antisocial behavior in later life and develop well-adjusted relationships.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) classifies APD by a range of personality and behavioral traits that describe how a person functions, how they relate to others, and how those beliefs express themselves by actions.
Self-functioning characteristics are those that reflect what a person is like and how that person views his or her actions or goals. In order to be diagnosed with APD, you must exhibit all of the following characteristics:
- Attaining self-esteem from power, personal gain, or pleasure
- Egocentricity or self-centeredness
- Setting goals based on personal gratification with little regard to law or ethics
Interpersonal characteristics are those that describe how a person interacts with others in general. You must also exhibit these traits to be diagnosed with APD:
- A lack of empathy for other people’s suffering or hurt or when confronted with the hurt or anger of people they have manipulated
- The inability to have a truly mutually emotionally intimate relationship because of the instinct to control (by dominance or intimidation), coerce, or deceive
Behavioral characteristics complete the clinical diagnosis by describing the route a person will take to either control, coerce, or deceive, such as:
- A strong tendency to disregard commitments, promises, and agreements, including financial ones
- Difficulty in making plans, preferring to believe you’re able to nimbly navigate problems as they appear
- It is not uncommon for someone with APD to be in repeated fights or assaults.
- Lying as a means to gain social entry or advantage, such as proclaiming yourself a decorated war hero when you have never served
- Making decisions on the spur of the moment with little regard to consequence if an immediate goal is to be achieved
- Persistent anger or irritability, even over small things, as well as mean, spiteful behavior
- Reacting with callousness, aggression, remorselessness, or even sadism when confronted by the fallout of your actions
- Risk taking, becoming easily bored, and an ability to ignore personal boundaries and justify even the most outrageous of actions
- The emotional manipulation of others—for example, pretending to be interested in someone simply to achieve a goal
APD has no cure or first-line recommended treatment. Instead, therapeutic strategies often focus on problematic behavior, coping skills, and comorbidities such as substance use disorders. Typical approaches include:
- Talk therapy (individual and group)
- Cognitive behavioral therapy (CBT)
- Mentalization-based therapy (MBT)
- Democratic therapeutic community (DTC)
- Impulsive lifestyle counseling
- Medications (antidepressants, antipsychotics, mood stabilizers)
Psychopaths and Sociopaths vs. Narcissists
Despite common usage and some overlap of features, not all people with narcissism are sociopaths/psychopaths, and not all sociopaths/psychopaths are narcissists.
Sociopathy falls under the classification of antisocial personality disorders, which are marked by ”a pervasive pattern of disregard for, and violation of, the rights of others.” In contrast, narcissism is a distinct personality disorder.
However, DSM-V classifies both antisocial and narcissistic personality disorders as cluster B personality disorders, a category that also comprises borderline and histrionic personality disorders.
In practical application to daily life, the main differences lie in the person’s intent. People with narcissistic personality disorder (NPD) are self-serving; they exaggerate their self-importance, crave constant praise, go to great lengths to feed their ego, and are exceedingly concerned with image, For these reasons, narcissists often appear to be successful and high-functioning. Unlike sociopaths, some narcissists are capable of empathy and remorse. People whom the narcissist hurts are merely unintended casualties on the way to a desired result.
The American Psychiatric Association (APA) estimates the prevalence of NPD at 0% to 6.2% of the population.
On the other hand, sociopaths intend to harm others and often derive pleasure in the act. They aren’t concerned with what others think of them; they lack the narcissist’s preoccupation with image, which frequently translates to an inability to hold a job and maintain relationships.
The APA estimates the rate of APD at 0.2-3.3%. It’s most common among men who have alcohol and/or substance use disorder, those in prison and other forensic settings, and those living in poverty and other adverse conditions.