You may have heard people call someone else a “psychopath” or a “sociopath.” But what do those words really mean?
You won’t find the definitions in mental health’s official handbook, the Diagnostic and Statistical Manual of Mental Disorders. Doctors don’t officially diagnose people as psychopaths or sociopaths. They use a different term instead: antisocial personality disorder.
Most experts believe psychopaths and sociopaths share a similar set of traits. People like this have a poor inner sense of right and wrong. They also can’t seem to understand or share another person’s feelings. But there are some differences, too.
Do They Have a Conscience?
A key difference between a psychopath and a sociopath is whether he has a conscience, the little voice inside that lets us know when we’re doing something wrong, says L. Michael Tompkins, EdD. He’s a psychologist at the Sacramento County Mental Health Treatment Center.
A psychopath doesn’t have a conscience. If he lies to you so he can steal your money, he won’t feel any moral qualms, though he may pretend to. He may observe others and then act the way they do so he’s not “found out,” Tompkins says.
A sociopath typically has a conscience, but it’s weak. They may know that taking your money is wrong, and they might feel some guilt or remorse, but that won’t stop their behavior.
Both lack empathy, the ability to stand in someone else’s shoes and understand how they feel. But a psychopath has less regard for others, says Aaron Kipnis, PhD, author of The Midas Complex. Someone with this personality type sees others as objects he can use for his own benefit.
They’re Not Always Violent
In movies and TV shows, psychopaths and sociopaths are usually the villains who kill or torture innocent people. In real life, some people with antisocial personality disorder can be violent, but most are not. Instead they use manipulation and reckless behavior to get what they want.
“At worst, they’re cold, calculating killers,” Kipnis says. Others, he says, are skilled at climbing their way up the corporate ladder, even if they have to hurt someone to get there.
If you recognize some of these traits in a family member or coworker, you may be tempted to think you’re living or working with a psychopath or sociopath. But just because a person is mean or selfish, it doesn’t necessarily mean they have a disorder.
When people are “difficult” to be around, it’s easy to toss off labels like sociopath or narcissist—especially if the person seems to be totally full of themself or have no remorse for the way their actions might affect you. But while they share some similarities, sociopathy and narcissism are two distinct psychological disorders. Understanding them may make it easier to deal with someone who seems to be one or the other.
Sociopaths and narcissists: what they have in common
“Both sociopaths and narcissists have personality disorders, meaning that certain personality traits are so extreme that it causes harm to themselves or others, or causes multiple losses and failures in life, such as losing jobs or important relationships, or failing in school,” Aimee Daramus, PsyD, a Chicago-based licensed clinical psychologist, tells Health.
People with both disorders value themselves above others, can’t step outside their awareness of what they want and need, and consider others’ feelings as secondary or a non-issue for them. They can also be charismatic and charming. But those traits are coming from different psychological places, and for different reasons.
Traits all narcissists share
“A narcissist is essentially somebody who is self-obsessed to an extreme degree,” Darrel Turner, PhD, a forensic psychologist in Louisiana, tells Health. “This is someone who has a high level of confidence and belief in themselves, but to a very unhealthy and harmful extent—to the point at which it actually distorts their sense of reality about themselves, other people, and the world around them. It can also lead them into manipulative and exploitative behavior, because they will prioritize their own needs above anyone else’s.”
That definition can seem broad, especially with the #selfie generation and in today’s cutthroat work culture. But people frequently misuse the term narcissist. “Just because someone is ‘full of herself’ or takes advantage of others doesn’t necessarily mean they are a full-blown narcissist,” says Turner.
To be diagnosed with narcissistic personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders V, someone would have an exaggerated sense of self-appraisal, set goals based on gaining the approval of others, set unreasonable high personal standards, lack empathy, be antagonistic, demonstrate feelings of entitlement, make excessive attempts to attract and be the focus of the attention of others, and firmly hold to the belief that they are better than others. It’s not a phase or a mood; it’s a lifelong disorder.
Above all is the narcissist’s need to be the most important, Daramus says. “That usually comes out of insecurity, but occasionally you get it coming out of a place of privilege, from someone who has genuinely never been exposed to the idea that other people matter,” she says.
What drives a sociopath
Sociopaths—people who are actually diagnosed with antisocial personality disorder—have many narcissistic characteristics, but this psychological disorder is typically much more dangerous. “Whereas a narcissist may occasionally harm people as a consequence of their self-prioritization, the harm they cause to others is usually unintentional,” explains Turner. “More often than not, it’s a consequence of their self-obsession rather than the motivator which drives them. A sociopath, on the other hand, essentially ‘gets off’ by hurting other people.”
That doesn’t mean every sociopath is a serial killer. “It’s actually more common for a sociopath to be driven by a need to control and manipulate other people, to damage them in some way, and to gain money and power,” Turner says. “They are more likely to be in a parasitic or controlling/abusive relationship with a romantic partner; to engage in risky activities like drugs, problematic gambling, and promiscuous sex; to backstab and sabotage their colleagues at work; and to carry out financial fraud schemes.”
Someone with APD, according to the DSM-V, is egocentric, acts based on personal gratification, lacks empathy, is incapable of intimacy, and is manipulative, deceitful, callous, risk-taking, and impulsive. “A sociopath is someone who, on a biological level, is lacking awareness of others’ feelings, and isn’t all that interested in anybody else’s rules,” says Daramus. “They’re far more charming and exciting than most narcissists, whose charm is more superficial. Because of the lack of empathy, sociopaths feel little or nothing when they hurt or take advantage of others.”
Sociopaths are especially dangerous because they often go to great efforts to hide their true personality and appear likable, adds Turner. A true narcissist, on the other hand, often doesn’t—and couldn’t—try to hide what they are.
Given their psychological makeups, it’s unlikely that someone diagnosed with narcissistic personality disorder of antisocial personality disorder would think they need or ever seek help. If you suspect you’re dealing with someone who may have either disorder, don’t get swept up into their world view—and make sure to watch out for your own interests.
Many people use the terms sociopathy and psychopathy interchangeably, but they have different meanings. “Sociopath” is an unofficial term to describe a person who has antisocial personality disorder (ASPD), whereas psychopathy describes a set of personality traits. However, ASPD and psychopathy can overlap.
ASPD and psychopathy share some similar traits, including aggression and a lack of remorse. Additionally, both can occur due to genetic and environmental factors.
However, unlike ASPD, psychopathy is not an official diagnosis. Another difference is that psychopathic traits tend to be more severe than those of ASPD.
This article defines ASPD and psychopathy before discussing their symptoms, causes, and treatment options.
What is ASPD?
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ASPD is a form of personality disorder. A personality disorder is a condition that affects how a person thinks, feels, and behaves.
The American Psychiatric Association states that ASPD can cause behavior that ignores or violates other people’s rights.
ASPD is a cluster B personality disorder. The disorders in this category typically involve dramatic, emotional, or unpredictable interactions with other people.
A healthcare professional can only diagnose a person with ASPD if they are over the age of 18 years. The reason for this is that a person’s personality is still developing until this age.
A person will usually only get a diagnosis if there is evidence of them experiencing conduct disorder before the age of 15 years. Conduct disorder is a mental health condition that occurs in children and adolescents, causing behavioral and emotional problems.
What is psychopathy?
According to a 2015 article, healthcare professionals characterize psychopathy as involving:
- shallow emotional responses
- lack of empathy
- increased chance of antisocial behavior
However, psychopathy is not an official diagnosis.
Some researchers state that psychopathy is a form of ASPD, and healthcare professionals might diagnose ASPD in a person who demonstrates psychopathic traits. For instance, the American Psychological Association describes psychopathy as another term for ASPD.
Other researchers say that psychopathy is a separate condition but acknowledge that it has traits that overlap with those of ASPD. Research supports this overlap, with one study estimating that approximately one-third of people with ASPD meet the criteria for having psychopathy.
Some researchers have also described psychopathy as a more violent version of ASPD. An article from the journal Current Biology also notes that people with high psychopathic traits show a noticeable lack of guilt and empathy.
What are the symptoms?
The symptoms of ASPD and psychopathy overlap, but there are differences between them.
For a healthcare professional to diagnose ASPD, a person must display at least three of the following criteria:
- disregarding the law
- being deceitful
- acting impulsively or being incapable of planning
- being irritable and aggressive
- disregarding safety
- being consistently irresponsible
- having a lack of remorse
ASPD is estimated to occur in approximately 1–4% of people. ASPD is also more likely to occur in males than in females.
Canadian psychologist Robert Hare developed the Psychopathy Checklist-Revised (PCL-R) in the 1990s to determine whether a person had psychopathy.
According to a 2014 article, while healthcare professionals would classify only 1% of the population with psychopathy using Hare’s checklist, approximately 20% of people in prison in North America would meet the criteria for psychopathy.
ASPD and psychopathy share many symptoms. However, additional signs that may indicate that a person has psychopathy include:
- lack of empathy
- excessive vanity
- lack of guilt
- difficulty processing other people’s facial expressions
- goal-oriented behavior
- insensitivity to punishment
Both conditions can occur due to a combination of genetics and a person’s environment.
Healthcare professionals do not know for sure why some people develop ASPD. However, both environmental and genetic factors can contribute.
The United Kingdom’s National Health Service (NHS) suggests that traumatic childhood experiences, such as neglect or child abuse, can play a role in developing ASPD.
The NHS also states that a person with ASPD may have grown up with challenging family circumstances. For instance, they may have experienced:
- conflict between parents or caregivers
- inconsistent parenting
- parents or caregivers who misused alcohol or drugs
Additionally, research suggests that 38–69% of people with ASPD inherit it from their parents. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), children of both adoptive and biological parents with ASPD have an increased chance of developing the condition.
Similar to ASPD, psychopathy can be due to both genetic and environmental factors.
The authors of a Current Biology article note that studies involving twins have shown that psychopathic traits may be moderately or highly inheritable. They also state that antisocial behavior with psychopathic traits is more inheritable than antisocial behavior alone.
In a 2016 study looking at the brains of males with psychopathy, researchers found poor connections between the amygdala and the prefrontal cortex. The amygdala is the part of the brain that processes emotions, while the prefrontal cortex plays a role in decision-making.
The researchers also found high levels of testosterone in these individuals, which may help explain why psychopathy is more common in males than females.
However, this research involved only a small number of male participants, so further research is necessary to confirm the results.
Traumatic brain injury and damage to the prefrontal cortex in childhood may also cause psychopathic traits to develop.
Neither ASPD nor psychopathy currently has a cure. However, certain treatments can help a person manage the symptoms of these conditions.
ASPD can be challenging to treat. Therefore, doctors may focus the treatment on managing certain symptoms or conditions that occur alongside ASPD rather than ASPD itself.
Treating conduct disorder when it occurs in a child may help reduce certain ASPD behaviors as they get older.
Treatment options for ASPD include:
- Cognitive behavioral therapy (CBT): CBT is a form of therapy that helps a person identify and change destructive thought patterns and behaviors. CBT may help a person with ASPD behave in a way that people consider “socially acceptable.”
- Mentalization-based therapy (MBT): MBT explores how a person’s mental state can affect their relationships.
- Medications: Certain medications, including mood stabilizers, antidepressants, and selective serotonin reuptake inhibitors, can treat different symptoms of ASPD.
In the U.K., a person with ASPD may be able to take part in a democratic therapeutic community (DTC). In this type of social therapy, people join therapy groups that focus on community issues and allow everyone involved to contribute to decisions. There may also be opportunities for vocational and educational work.
However, acceptance into a DTC depends on a person’s willingness to be part of a community.
As with ASPD, psychopathy can be very hard to treat. Individuals with psychopathy may not agree that they need treatment, or they may not commit to treatment.
Starting treatment in childhood for psychopathic traits can be helpful in reducing them. CBT may also be useful when treating children who develop psychopathic behaviors following traumatic brain injuries (TBIs).
A 2014 case series found that clozapine reduced the severity of ASPD and psychopathy symptoms in males. Clozapine was especially beneficial in reducing anger, aggression, impulsive behavior, and violence. However, the study was small and only included males, so further research is necessary to confirm these effects.
Relation to narcissism
The DSM-5 characterizes narcissistic personality disorder as “a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts.”
A person with NPD will have:
- a need to be admired
- a sense of entitlement, such as unreasonable expectations of favorable treatment
- an inflated sense of self-importance
- a lack of empathy
They may also be arrogant, exploitative, and envious of others.
Individuals with either NPD or ASPD can be tough-minded, superficial, exploitative, and unempathetic. However, those with NPD are not necessarily impulsive, aggressive, or deceitful. In addition, those with NPD typically lack a history of conduct disorder and criminal behavior.
Conversely, those with ASPD do not typically require the admiration and envy of other people.
Research from 2014 found that people with NPD and people with psychopathy both showed low honesty, humility, and agreeableness. However, individuals with psychopathy were also unlikely to be caring or responsible.
Myths and facts
Many myths surround ASPD and psychopathy. Two common myths are:
Myth 1: People with psychopathy are always violent
Although people with these conditions are more likely than other people to be violent, this is not always the case. Research from 2020 found that certain people with psychopathy were able to inhibit violent tendencies, leading to greater success in life.
Myth 2: Prisons are full of psychopaths
Psychopathic people may be more likely to commit criminal acts than other people. However, according to estimates, only about 20% of people in prison in North America have psychopathic traits.
Sociopath is an unofficial term to refer to a person with ASPD. Psychopath is an informal way to describe an individual who displays psychopathic traits.
ASPD is a personality disorder. Some researchers believe that psychopathy is a form of ASPD, whereas others say that it is a separate condition.
Psychopathy shares similar traits with ASPD. However, psychopaths tend to have more violent and severe behavioral traits than people with ASPD. Both conditions can occur due to genetic or environmental factors, and psychopathy can also occur due to TBIs.
There is no cure for either condition, so treatments for both conditions seek to manage and control a person’s symptoms.
If a person thinks that they or a child in their care may have ASPD or psychopathy, they should speak with a doctor or mental health professional.
Do those with ASPD have a conscience?
The more common perceptual lens is one that is imbued with empathy and a conscience. People with ASPD lack what we consider a conscience and, as such, are not governed with the usual moral, legal, or philosophical prohibitions to behaviors that meet their own needs, regardless of the impact on others. These people can be manipulative, chaotic, and, at times, dangerous.
Jeffrey Ditzell, DOAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.