- I get asked a lot, what's the difference between the term psychopath and sociopath? The main difference is that the term psychopath or psychopathy is a scientific and clinical term, and the term sociopath or sociopathy is not. - [Narrator] Psychopathy explained, traits and treatments.
- For some reason, it's sticky. People really like the term. And so you do see it used a lot in book titles and lots of media coverage, but there's really no scientific definition of sociopathy.
There's no sort of clinical set of traits that constitute it and no agreed upon definition of what it even means. The most common thing that is meant by the term sociopath is somebody who is diagnosed with antisocial personality disorder. So that is a disorder in the Diagnostic and Statistical Manual or the DSM-5, which psychiatrists and psychologists use to diagnose any psychological disorder.
And once upon a time it was pretty common to call people who had a diagnosis of antisocial personality disorder a sociopath. I don't think anybody does that anymore, I don't think. I hope not.
However, that's just not accepted terminology really in any group of professionals. By contrast, the term psychopathy is an established scientific term. It has very clearly delineated sort of symptoms and a well understood definition.
There are scientific societies that study psychopathy. You'll see thousands of mentions of it in the scientific literature. You'll see no mentions of sociopathy in the scientific literature.
And so I wish people would use just the term psychopathy. And I think the reason they don't is A, it's a really annoyingly confusing term. It sounds a lot like psychopathology, which means any kind of psychological disorder.
It also has really negative connotations. People associate the term psychopath was the old idea of like the bad seed people who were just born bad, which seems I think needlessly pejorative. And for a while, the term sociopath caught on maybe 40 or 50 years ago because beliefs about the origins of antisocial personality traits changed.
And for a while people assumed that all antisocial personality traits were the result of social experiences. So you would develop these traits not because you were a bad seed, but because you would've been exposed to abuse or maltreatment or trauma. And the term sociopath is sometimes used to signify that origin of anti-social behavior.
Now we know it's a lot more complicated. You can never ask the question is some outcome the result of nature or nurture because they're always acting in combination. I think it would be helpful to banish the term sociopaths, mostly because I get a little frustrated by the euphemism treadmill that we sometimes get on for stigmatized disorders.
That really happens with psychopathy. There's this attempt to keep coming up with new sort of less stigmatized names for the concept that we are studying. But what I've noticed is that this makes life a lot more difficult for the people and their families affected by these disorders.
It makes it really hard to find information out about what the disorder is, how is it diagnosed, how do you treat it if you're not even sure, like what the disorder's name is and sort of what to look for, what to ask about. And so I would prefer if we all just stuck with one word, psychopathy, which has a really well accepted meaning and is already the focus of tons and tons of scientific research. I don't think adding another term in is really helping anybody.
Adding layers to the confusion is the fact that in the DSM, there is a diagnosis called antisocial personality disorder that has a lot of overlap with psychopathy. At core, they both refer to people who engage in persistent and fairly severe antisocial behavior, don't seem to care about other people's welfare, et cetera. The difference is that people who were psychopathic may or may not engage in any criminal behavior, right?
You can be an uncaring person and not break the law. And it's really much more about a person's personality and their sort of internal traits whereas antisocial personality disorder is much more about external behaviors in particular crime. So almost anybody who's committed more than one crime has a very high likelihood of a diagnosis of antisocial personality disorder.
And I think that's inappropriate and also unhelpful. Most psychological disorders are really focused on how is the person feeling, what is the way that they engage with the world around them, not coming up with a checklist of behaviors that they engage in necessarily. And I think it would be better if we did that for disorders of aggression and anti-social as well, like psychopathy.
Psychopathy is obviously a very popular topic for the media. It's a thrilling sensationalistic topic. And so there are a lot of really compelling psychopaths in the media that I think unfortunately causes people to develop a lot of false impressions about what psychopathy really is and what it's about.
So unfortunately, most people do have a lot of false beliefs about the reality of psychopathy. One is that it's extremely rare, it's not. The estimate is that about 1% of adults have clinical levels of psychopathy, which is just as common as schizophrenia or bipolar disorder or some other relatively common disorders.
Another is that people who are psychopathic are sort of born, not made. And that's not 100% true because we now know that psychopathy results from a mix of genetic and environmental, just like every other psychological disorder. Interestingly, other people have the alternate false belief, which is that psychopathy is 100% about life experiences, not about anything that you bring to the world.
That's also untrue. And I think it's a really pernicious myth that the only way to end up psychopathic is if you were abused or maltreated as a child because many families of children who end up psychopathic are too ashamed to come forward with their problems because they assume everybody will blame them and often they do. Another common myth about psychopathy is that it's a disorder exclusively seen in men, which is also not true.
These numbers are always a little bit fuzzy because again, they're continuous and we draw the line. But however, it is true that men are more likely to have high levels of psychopathy with men being roughly twice as likely to have a clinical assessment of psychopathy as women are. And when they are a psychopathic, it's more likely to manifest in violence or physical aggression.
Women can also be psychopathic and sometimes can be violent or aggressive, although they're more likely to show behaviors like emotional aggression, threatening, emotional blackmail, bullying and ostracizing to manipulate people or to get what they want. That's a very common myth that conflates psychopathy with violence that assumes that psychopathy and for example, serial killers are basically the same thing. That's definitely not true.
Although people who are psychopathic are more likely to be violent than the average person, especially if they're men, there are plenty of reasons that people can be violent that have nothing to do with psychopathy. And there's some evidence that most people who have high levels of psychopathy are not violent. They may not always do the nicest things, but their disorder doesn't always manifest as physical aggression.
Another myth is that psychopathy is untreatable. A lot of people believe that if you are psychopathic, then that's that and you can never change. Psychopathy is difficult to treat because often people with psychopathy don't believe they need treatment and sometimes don't want treatment.
But if they can come to believe correctly that their own behavior and the way they treat people is blowing up their own life and they are the root cause of those problems, you have to use validated treatment approaches, which sometimes involve medication and sometimes involve psychotherapy to help them learn new ways to behave and new ways to engage with other people, which we know can help both them and the people around them. Some of the medications that seem to help people with psychopathy include psychostimulants that are used to treat ADHD, for example. It seem to reduce the impulsiveness and disinhibitedness of people with psychopathy.
There's some evidence that antipsychotic medication can also help, not because people with psychopathy are psychotic unnecessarily, although some are also psychotic, but antipsychotic medications act on the dopamine system as well as other neurotransmitters that also seem to be implicated in the behavior of people with psychopathy. So this medication may help them as well. Forms of psychotherapy that seem to be effective in adults include cognitive behavioral therapy, which involves simply learning new behaviors, learning that there are other ways to respond to situations that crop up in your life and new ways of thinking about the world that involve overcoming false assumptions about other people.
For example, many people who are at risk for aggression have what's called a hostile attribution bias. That means they interpret other people's ambiguous behavior as hostile, which makes you more likely to respond aggressively as a result. And you can retrain people so that they don't interpret other people's behavior through that hostile lens.
When it comes to children, the very best forms of treatment for children at risk for psychopathy are various forms of parent management training. So the therapist trains the parents to use new approaches to managing their child's disruptive behavior. There's a form of therapy called parent management training.
There's another very effective therapy called PCIT that coaches parents on ways to reduce their child's disruptive and aggressive behavior. I think the most effective resource for learning about effective ways to treat psychopathy is to go to the psychopathyis. org website.
And we have a whole section for clinicians and for parents and for adults affected by psychopathy on what the effective forms of treatment out there are. The way we think about psychopathy now derives from the work of a psychiatrist named Hervey Cleckley, who was a really legendary clinician who spent many, many years studying people with psychopathy in psychiatric hospitals. And he wrote a book called The Mask of Sanity.
And I think that title perfectly captures what it is that makes people with psychopathy unique, which is that they outwardly appear completely normal, even super normal. They seem just like anybody else, but that really is a mask that's concealing inner profound deficits in emotion and the way that they engage with other people. In particular, a true lack of caring about other people's welfare.
Some people would refer to that as a real deficit in the ability to love other people the way that we usually think of love as truly caring about other for their own sake. And that I think is the most useful way to think about psychopathy. It's a disorder that results in people having this outwardly charming, agreeable, pleasant demeanor often, but being really unable to connect with other people on a deep level or experience certain emotions like fear or like love.
In its extreme form, psychopathy can drive some of the most serious antisocial behavior and violence that we see. So for example, the serial killer Gary Ridgway is somebody that the FBI profiler, Mary Ellen O'Toole, has called perhaps the most psychopathic criminal she has ever interviewed. And it's clear from his behavior he killed dozens of young women over the course of a few decades.
We'll probably never know exactly how many. And also the way he talked about them and the way he responded when asked about what he had done made it clear just how little he valued their welfare. He didn't think that they mattered, he didn't think that there was any reason that he should restrain his sexual urges just because it would result in these women's suffering and deaths.
And that is unfortunately the most extreme manifestation that you sometimes see in people with psychopathy. The thing that I think unnerves people the most about serial killers like Gary Ridgway or like the BTK killer is just how normal they seem to everybody around them. They had families, they were known members of their community that were not caught for many years, in part because nobody suspected that they could be doing such horrible things under the surface.
And that's a really good example of The Mask of Sanity. There's somebody doing things that are so awful under the surface that you would think there must be some sign of it externally. But in the case of some people with psychopathy, there really isn't.
It's very difficult to know whether the person you're interacting with is psychopathic just from a brief interaction. There's some people who will tell you there are certain tells relating to the way they use eye contact or things, but I've never found that to be true. I've often said that if you were to line up all the adolescents that I've studied who have psychopathic traits next to all the healthy adolescents I've studied and asked you to pick out who's who, you'd never be able to.
However, what you're looking for to try to identify somebody with psychopathy is patterns of behaviors that people with psychopathy engage in. The first one is a tendency to exploit other people. So people who are psychopathic, again, they just don't value other people's welfare.
And so they will do things that exploit other people without any sense of remorse or guilt. So they'll steal things from people, they'll steal things from stores, they'll lie, and they'll lie often easily and not really even for any reason. Like it doesn't bother them to know that somebody who thinks that they care about them has been deceived and might feel betrayed by that.
They will cheat in romantic relationships frequently and again without any particular care about it. They're more likely to cheat on exams, they're more likely to commit fraud. They're certainly more likely to engage in various forms of aggression, especially when that aggression is aimed at achieving a goal.
So aggression can be divided into two broad categories. Reactive aggression, which is the kind of aggression you show when somebody has made you mad, when you've been threatened, when you're frustrated. And then there's proactive aggression, which is aggression that's not really out of a spontaneous sort of rage or frustration.
It's deliberate aggression aimed at achieving a goal. So you threaten to hurt somebody in order to take their money or to take something that belongs to them. You threaten to reveal somebody's secrets so that they do what you want them to do.
That kind of aggression is really uniquely psychopathic. However, because people who are psychopathic are also disinhibited and impulsive, they also show the other kind of aggression, which is reactive aggression. So you've been frustrated or you've been irritated by somebody and you lash out in response.
That's a much more common form of aggression that people with psychopathy also show. I've spent many years conducting research and brain scans in adolescents who were psychopathic. And some of the stories that they've told me over the years are really astonishing and I think really illustrate the nature of their disorder.
One girl I worked with was really good at crying on cue to get outta trouble. She could feign emotions really, really well to manipulate people. And she said that she would size up adults to see whether they would be more likely to let her off the hook for, for example, shoplifting or cheating in school, if she used really big words and sound really grown up, or if she cried and seemed really remorseful.
And she told a story about one time when her mother had caught her shoplifting from the mall. And it so happened that her mother had also found in her bag a printout from the internet that was a list of instructions on how to shoplift. So her mom knew that this was not just a sort of random spontaneous thing, it had been planned out, which is characteristically psychopathic.
The girl did not know her mom had seen this printout. So when she was caught shoplifting, she burst into tears and said how sorry she was. And because her mother knew what had actually happened, she said, oh, come off it, she just didn't have the time for the tears.
And she said, what was so unnerving was that when she said, I'll come off it, the girl's tears stopped like a switch had been turned off. It had been completely a false display of emotion. The same girl took her parents' car joy riding.
On one occasion, she just decided she was looking for a thrill, stole the parents' car keys, took the car off speeding on country roads so fast and out of control 'cause she was too young to drive that she eventually careened off the road, crashed into a tree and flipped the car. And when the police came across the accident, sometime later, they assumed that whoever had been in the car had died because the accident was so awful. And they tracked down the parents' house from the car's registration, knocked on the door prepared to tell them, we think that whoever took this car is dead and there was the girl sitting on the couch eating Doritos, like nothing at all had happened, right?
Completely unfazed by the whole incident. It's unnerving to hear stories like this from a girl who outwardly is very appealing, very smart, very well spoken, and there's nothing at all to reveal the kinds of things that she's capable of in brief conversations. So it is hard to work with people who are psychopathic and not start to get a little paranoid or a little cynical because of the really extreme disjunction between what's on the outside and what's on the inside.
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