The term sociopath refers to someone living with antisocial personality disorder (ASPD) — as does the term psychopath.
The most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), which mental health professionals use to diagnose mental health conditions, defines ASPD as a consistent disregard for rules and social norms and repeated violation of other people’s rights.
People with the condition might seem charming and charismatic at first, at least on the surface, but they generally find it difficult to understand other people’s feelings. They often:
- break rules or laws
- behave aggressively or impulsively
- feel little guilt for harm they cause others
- use manipulation, deceit, and controlling behavior
Both sociopathy and psychopathy have become well-recognized terms among mental health professionals, but neither represent an official diagnosis. They also carry a lot of stigma, particularly for people living with personality disorders, so it’s best to avoid describing anyone displaying violent or manipulative behavior as “sociopaths” or “psychopaths.”
Instead, focus on specific behaviors and actions. Rather than labelling a controlling ex as a sociopath, for example, you could say, “He would regularly remind me he was monitoring my social media activity.”
Experts first began using the term sociopathy during the 1930s. Unlike “psychopathy,” it wasn’t easily confused with “psychosis.” The prefix also reflected a widely-held belief that the traits and behaviors associated with sociopathy related to socio-environmental factors.
Many researchers used sociopathy and psychopathy interchangeably until ASPD was added to the third edition of the DSM in 1980.
In a clinical setting, there’s no actual difference between sociopathy and psychopathy. A mental health professional won’t diagnose either of the two.
Some psychologists and researchers do make key distinctions between sociopathy and psychopathy. But these terms simply offer two slightly different ways of understanding the diagnosis of ASPD
In these interpretations, psychopathy is sometimes seen as involving more planned behavior. The behavior might not necessarily be violent, but it’s typically premeditated.
Research supports a few of these distinctions — to an extent.
Robert Hare, the psychologist who created the Psychopathy Checklist (PCL-R), defined sociopathy as involving a conscience and sense of right and wrong, or morality. But that sense of morality doesn’t line up with cultural and social norms. Instead, people with sociopathy often justify actions they recognize as “wrong.”
In a nutshell, people with sociopathy may have little empathy and a habit of rationalizing their actions. But they do know the difference between right and wrong.
Psychopathy, according to Hare, involves no sense of morality or empathy.
Research from 2013 suggests the difference between psychopathy and sociopathy may relate to differences in the brain, including gray matter volume and amygdala development. For people with sociopathy, increased neuron function in certain parts of the brain may factor into the development of some sense of morality.
There’s no standard list of sociopath signs, but the signs and symptoms of ASPD include a persistent pattern of disregard for others. For example:
- ignoring social norms and laws, or breaking rules at school or work, overstepping social boundaries, stealing, stalking and harassing others, and destroying property
- dishonesty and deceit, including using false identities and manipulating others for personal gain
- difficulty controlling impulses and planning for the future, or acting without considering the consequences
- aggressive or aggravated behavior, including frequent fights or physical conflict with others
- disregard for personal safety, or the safety of others
- difficulty managing responsibilities, including showing up at work, handling tasks, or paying rent and bills
- little to no guilt or remorse, or a tendency to justify actions that negatively affect others
People with ASPD generally show little emotion or interest in the lives of others. They might:
- come across as arrogant or superior, with firmly fixed opinions
- use humor, intelligence, and charisma to manipulate
- seem charming at first, until their self-interest becomes clear
People with ASPD generally find it challenging to maintain friendships, relationships, and other mutually fulfilling connections. This difficulty may stem from traits, like:
Many experts consider sociopathy more of an environmental construct than a genetic one.
Yes, brain chemistry and inherited genes play a part, but parenting styles and upbringing, along with other environmental factors, carry the most weight. (Psychopathy, on the other hand, appears linked to more innate biological factors.)
Children who don’t receive nurturing attention from caregivers tend to grow up learning they have to take care of themselves, because no one else will. Some children who experience abuse, violence, and manipulation from an early age may come to model this behavior as they navigate their own conflicts.
Research also suggests it’s possible to “acquire” sociopathy. Trauma or damage to the frontal lobes of the brain, which can happen as a result of a head injury or progressive conditions, like dementia, can lead to some antisocial behaviors.
Again, keep in mind that the DSM-5 makes no distinction between sociopathy and psychopathy, or any separate subtypes of ASPD.
Mental health professionals use DSM-established criteria to diagnose ASPD. This diagnosis can apply to someone whose behavior aligns with the accepted definition of either sociopathy or psychopathy.
A diagnosis of ASPD requires at least three of the seven signs listed above, plus a few additional criteria:
- These behaviors appear across multiple areas of life.
- The person is at least 18 years old.
- They had some symptoms of conduct disorder before the age of 15. This helps distinguish ASPD from lawbreaking behavior that begins in adulthood.
- Antisocial traits and behaviors don’t relate to schizophrenia or bipolar disorder.
To make a diagnosis, a therapist or psychologist might:
- ask questions about a person’s feelings, thoughts, behavior, and personal relationships
- ask (with permission) family members and romantic partners about their behaviors
- evaluate their medical history for signs of other conditions
Keep in mind that personality disorders, including APSD, involve traits that are beyond the person’s control. These characteristics go beyond a desire for personal gain and tend to remain fixed over time, causing distress.
Could it be a different condition?
Other mental health conditions can involve symptoms similar to ASPD:
- Intermittent explosive disorder (IED) involves extreme and repeated verbal or physical outbursts. These outbursts, driven by impulse or anger, can be directed toward people, property, or animals. IED commonly begins in adolescence and usually before the age of 40. On its own, it doesn’t involve low empathy or lack of remorse.
- Conduct disorder involves antisocial behavior that typically begins by the age of 16. Experts consider this condition a major risk factor for ASPD. Adults must show signs of conduct disorder in childhood to be diagnosed with ASPD. Someone who doesn’t meet full ASPD criteria might be diagnosed with conduct disorder.
- Schizophrenia often involves trouble recognizing facial emotions, a trait also associated with ASPD. The condition may involve aggressive or antisocial behavior — but not always. It also involves psychosis, while ASPD does not. Experts won’t diagnose ASPD before treating schizophrenia.
- Bipolar I disorder. Episodes of mania can involve impulsivity, aggression and irritability, and increased thoughts of suicide — symptoms also linked to ASPD. Experts won’t diagnose ASPD during an episode of mania.
People living with personality disorders don’t always recognize any issues with their behavior, so they often don’t consider getting professional support.
They might choose to work with a therapist if prompted by a court order or someone in their personal or professional life.
Work supervisors, family members, and romantic partners might notice traits, like impulsivity and a tendency toward aggressive outbursts, for example, and they may recommend professional support.
Some people also try therapy to address other challenges or mental health concerns, including:
But since many people living with ASPD never choose to go to therapy, little research on helpful treatment approaches exists. That doesn’t mean treatment can’t help. But therapy and other approaches generally only work when someone willingly puts in the effort.
Possible treatments for ASPD include the following.
Therapy involves talking to a therapist about thoughts and feelings that can prompt harmful or aggressive behavior. It might also include anger management tactics or treatment for substance use.
Potentially beneficial approaches include:
- Cognitive behavioral therapy (CBT). CBT can help people learn to consider their responses to people and situations, which may lead to more productive behaviors. Therapy can, for example, help someone recognize the benefits of using negotiation rather than violence to solve conflict or disagreements. CBT also involves psychoeducation, which can teach people more about ASPD.
- Mentalization-based therapy (MBT). This approach aims to help people learn to better identify and understand mental and emotional mindsets — both their own and those of others. A small 2016 study suggests MBT helped reduce hostility and anger, paranoia, self-harm and interpersonal difficulties in people living with both ASPD and borderline personality disorder, along with leading to an improved mood overall.
- Democratic therapeutic communities. This approach, often used in prisons, involves therapy groups of various sizes that help participants make collaborative decisions as part of a group and work together on problems affecting the community. It can help boost community-minded and prosocial thinking in people living with ASPD.
- Contingency management. This approach offers rewards to encourage treatment progress. Older research suggests it can help people living with ASPD limit intake of alcohol and other substances.
The Food and Drug Administration (FDA) hasn’t approved any medications to treat symptoms of ASPD.
A doctor or psychiatrist may recommend medication for symptoms associated with the condition, such as:
According to a small 2014 study, the antipsychotic medication clozapine (Clozaril) shows some promise as a treatment for men with ASPD. After taking the medication for several weeks, all seven participants experienced improvement in ASPD symptoms, including anger, impulsivity, and violence or aggression.
If you’d like to work on maintaining your relationship with someone who has ASPD, it may help to:
- recognize they may never fully understand your emotions
- explain specific ways their behavior affects others
- establish clear boundaries to protect your emotional and physical space
- encourage them to get professional support
Marriage or family counseling can also help you develop a more positive relationship with a loved one living with ASPD.
Ultimately, they may choose not to respect your boundaries and continue to cause emotional distress or physical harm. In that case, ending the relationship, or at least creating space from it, may be your safest option.
Working with a therapist yourself can also help you:
A therapist can also offer more specific guidance on handling problematic behaviors, including manipulation and control tactics or outbursts of anger.
Personality researchers and experts continue to explore the nuances of sociopathy and psychopathy. Still, they have yet to establish unique criteria to diagnose either, and ASPD remains the closest diagnosis to what people typically think of as psychopathy.
There’s no cure for ASPD. Some research suggests, though, that antisocial behavior often decreases over time. By middle age, people are less likely to behave in violent or aggressive ways.
Therapy approaches that help people learn to replace problematic behaviors with more constructive ones can also make a difference for ASPD symptoms.
In short, it’s absolutely possible for people with ASPD to build stable and fulfilling relationships with others, though it does take work.
Contrary to media portrayals, people who show signs of sociopathy don’t choose to be “evil.”
In many cases, they’re likely living with ASPD, a condition that develops from a combination of genetic and environmental factors, including childhood abuse and neglect.