Menu

How Sociopaths and Psychopaths Are Different

Medically Reviewed by Smitha Bhandari, MD on December 07, 2020

You’ve probably heard of a “sociopath” or “psychopath.” These words refer to people who don’t care about right or wrong or can’t sense or share other people’s feelings. Maybe they describe a person who’s also charming or violent -- or both.

People often use these terms to mean the same thing. While experts agree so-called sociopaths and psychopaths share some similar traits, there are some important differences.

What Is Antisocial Personality Disorder?

Doctors don’t diagnose people as sociopaths or psychopaths. They use the term antisocial personality disorder. They used to call it sociopathy. A person who had this diagnosis was a sociopath. But doctors don’t use these labels anymore. There’s some debate over whether psychopaths have a serious form of this personality disorder or a separate but related diagnosis.

People with antisocial personality disorder act in ways that go against socially acceptable norms. They tend to break laws and feel little or no guilt when they do something wrong. This condition usually develops in childhood, but you can’t get a diagnosis until you’re 18 or older. (Doctors diagnose kids who have antisocial problems with conduct disorder.)

People with this personality disorder might do things such as:

  • Deceive others for personal gain.
  • Commit crimes.
  • Disregard rules or the safety of others.
  • Act impulsively or aggressively.
  • Act coldly toward others.
  • Lie about big and little things.
  • Have few, if any, close relationships.
  • Have trouble keeping a job or doing schoolwork.
  • Take unneeded risks.

What Is Psychopathy?

Psychopaths are people who demonstrate psychopathy. That’s not a diagnosis but a set of traits. The criteria for psychopathy include psychological symptoms and certain specific behaviors. The measures of antisocial personality disorder, on the other hand, focus mostly on behaviors you can see.

Around 25%-30% of people with antisocial personality disorder also have psychopathy. But you can’t know if someone has psychopathy just by testing them for antisocial disorder. Instead, a trained clinician will commonly use something called the Hare Psychopathy Checklist-Revised. That’s a list of 20 characteristics. The clinician will consider someone, usually a criminal, a psychopath if they “score” high on the checklist.

Here are some of the traits common to psychopaths:

  • Insincere charm
  • Easily bored
  • Compulsive lying
  • Manipulative
  • No remorse or guilt
  • Little emotional reaction
  • Cruel with no empathy
  • Take advantage of others
  • Behavior problems start in childhood
  • Don’t accept responsibility
  • Many sexual relationships

Studies focus mostly on male psychopaths. They make up about 1% of the general population, but they comprise 20%-30% of those in U.S. prisons. Research shows that psychopaths are 15 to 25 times more likely to break the law and end up in prison than others.

Do Either Have a Conscience?

People with antisocial personality disorder -- that is, sociopaths -- likely know what they’re doing is wrong. But their moral compass is weak. They have a conscience; it’s just not strong enough to stop their bad behavior.

But experts don’t think people with psychopathy have a conscience.

Are They Violent?

Anyone can hurt another person. That includes people with antisocial personality disorder. But they aren’t always violent. Psychopathy, on the other hand, is a strong predictor of aggression and violence over someone’s lifetime.

Here’s what some research shows:

  • About 90% of people released from prison who scored high in psychopathy committed a violent crime within the next 20 years. Only 40% of those who scored low in psychopathy did the same.
  • Psychopaths are responsible for the deaths of more than 50% of police officers who die in the line of duty.

Hot-Headed vs. Cold-Hearted

People with antisocial personality disorder who aren’t psychopathic are more likely to be impulsively aggressive. That means they are hot-headed or don’t have much control over their behavior when they get angry. They’re also not very good at planning for the future.

But psychopaths are more cold-hearted than hot-headed. Studies show they have low levels of anxiety, and they don’t react all that much to stress or punishment. Plus, they have good control over their thoughts and tend to plan out their aggressive acts.

What Causes It?

It’s unclear why some people get antisocial personality disorder or psychopathy. It’s likely that a bunch of different things play a part, such as:

  • The brain. Studies show that there may be a problem with the brain circuitry that controls behavior in people with this condition. Research also shows that certain parts of the brains of people with psychopathy are smaller. That includes the areas that control empathy, moral decision-making, guilt, and embarrassment.
  • Genetics. You’re more likely to get this disorder if someone in your family, such as a parent, has it.
  • Sex. Antisocial personality disorder and psychopathy can happen in females, but they are much more likely to show up in males.
  • Environment. There’s some evidence that people with this disorder don’t learn the difference between right and wrong as they’re growing up.

 

Can They Get Better?

Antisocial personality disorder is hard to treat. That’s partly because so-called sociopaths or psychopaths aren’t the kind of people who think they need help. But certain symptoms may show up in childhood. When that happens, if parents take action and get help for their child, they may get better.

There isn’t enough evidence to know if any kind of treatment will actually work. But if someone with this condition does get help, their doctor may try talk therapy to address anger issues or other mental health problems. Medication may help with behavior problems like aggression or depression, but drugs can’t cure antisocial personality disorder or psychopathy.

If you’re around someone who you think has this condition, look out for yourself. Find a support group or reach out to a mental health professional. Ask your doctor for a referral to someone who has experience treating people with personality disorders.

WebMD Medical Reference

Sources

SOURCES:

Kent Kiehl, PhD, professor of psychology, neuroscience, and law, University of New Mexico.

UpToDate: “Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis,” “Treatment of antisocial personality disorder.” 

Aggressive and Violent Behavior: “Why psychopathy matters: Implications for public health and violence prevention.”

Comprehensive Psychiatry: “Antisocial personality disorder is on a continuum with psychopathy.”

American Psychiatric Association: “What are Personality Disorders?”

Johns Hopkins Medicine: “Conduct Disorder.”

Mayo Clinic: “Antisocial personality disorder.”

Jurimetrics: “The Criminal Psychopath: History, Neuroscience, Treatment, and Economics.”

Brazilian Journal of Psychiatry: “Does every psychopath have an antisocial personality disorder?”

Frontiers in Psychology: “The Empathic Brain of Psychopaths: From Social Science to Neuroscience in Empathy.”

PLoS One: “Impulsive and premeditated aggression in male offenders with antisocial personality disorder.”

Current Topics in Behavioral Neurosciences: “Psychopathy & Aggression: When Paralimbic Dysfunction Leads to Violence.”

Cleveland Clinic: “Antisocial Personality Disorder.”

International Journal of Women’s Health: “Psychopathy in women: theoretical and clinical perspectives.”

Fisher, K.A., Hany, M. Antisocial Personality Disorder, StatPearls, 2020.

Scientific Reports: “Reduced White Matter Integrity in Antisocial Personality Disorder: A Diffusion Tensor Imaging Study.”

JAMA Psychiatry: “The Antisocial Brain: Psychopathy Matters: A Structural MRI Investigation of Antisocial Male Violent Offenders.”

Cochrane: “The use of medication to treat people with antisocial personality disorder.”

© 2020 WebMD, LLC. All rights reserved.