Psychopathy, while not a clinical diagnosis, often refers to someone with antisocial personality disorder.
Psychopathy
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.
ASPD
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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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.
Psychopathic diagnosis
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.
Diagnostic criteria
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:
- thoughts
- feelings
- behavior patterns
- relationships
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.
Age
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
- antipsychotics
- anticonvulsants
The takeaway
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.
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
- impulsivity
- 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.
ASPD
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.
Psychopathy
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
- arrogance
- charisma
- excessive vanity
- lack of guilt
- difficulty processing other people’s facial expressions
- goal-oriented behavior
- insensitivity to punishment
Causes
Both conditions can occur due to a combination of genetics and a person’s environment.
ASPD
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.
Psychopathy
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.
Treatment
Neither ASPD nor psychopathy currently has a cure. However, certain treatments can help a person manage the symptoms of these conditions.
ASPD
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.
Psychopathy
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.
Summary
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.
Q:
Do those with ASPD have a conscience?
Anonymous
A:
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.
