You’ve probably heard of a “sociopath” or “psychopath.” In popular culture, both words are often used to refer to someone who doesn't seem to care about right or wrong, tends to manipulate others, or has a hard time understanding other people's feelings.
But you won’t find definitions of either in the latest version of 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 (ASPD).
Still, some experts do use "psychopathy" to describe certain behaviors that can be part of ASPD, and "sociopathy" to mean the same thing as ASPD. In fact, "sociopathy" is the former name for ASPD.
What Is Antisocial Personality Disorder?
If you have ASPD, you may act in ways that go against socially acceptable standards. You may break laws and feel little or no guilt when you 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.)
If you have this personality disorder, you might do things like:
- Lie to or trick others for personal gain
- Commit crimes
- Disregard rules or the safety of others
- Act impulsively or aggressively
- Act coldly toward others
- Lie about both big and little things
- Have few, if any, close relationships
- Have trouble keeping a job or doing schoolwork
- Take unneeded risks
What Is Psychopathy?
Psychopathy is not a diagnosis but a set of traits. Around 25%-30% of people with ASPD also have psychopathy.
To see if someone has psychopathy, a trained health care provider will commonly use something called the Hare Psychopathy Checklist-Revised. That’s a list of 20 characteristics. Traits commonly linked to psychopathy include:
- Insincere charm
- Getting easily bored
- Compulsive lying
- Manipulation of others
- No remorse or guilt
- Little emotional reaction
- Cruelty without feeling bad about it
- Taking advantage of others
- Behavior problems that start in childhood
- Failure to accept responsibility
- Many sexual relationships
People with psychopathy make up about 1% of the general population, but 15%-25% of people in U.S. prisons. Research shows that those with psychopathy are 15-25 times more likely to break the law and end up in prison than others.
What’s the Difference Between Sociopathy and Psychopathy?
If you have ASPD, or sociopathy, you probably know you're doing something wrong when you do something wrong. But you may have little empathy for others. That means it can be hard for you to see things from someone else's perspective or understand how they feel. So even though you may know something you're doing is harmful or unethical, that's not enough to stop you from doing it.
On the flip side, some experts think people with psychopathy lack a sense of empathy or morality. Compared to someone with ASPD who doesn't have psychopathy, you may feel less regard for others. Others think it's just much harder for you to predict when your actions will lead to harmful consequences.
Are People With Antisocial Personality Disorder Violent?
Anyone can hurt another person. That includes people with antisocial personality disorder. But just because you have ASPD doesn't mean you're violent. If you have psychopathy, though, you might be more prone to aggression and violent behavior over the course of your lifetime.
Here’s what some research has shown:
- About 90% of people released from prison who scored high in traits of psychopathy committed a violent crime within the next 20 years. Only 40% of those who scored low in psychopathy did the same.
- People with psychopathy are responsible for the deaths of more than 50% of police officers who die in the line of duty.
Impulsivity and Reactivity
When you have ASPD, even if you don't have psychopathy, you may be more likely to be impulsively aggressive. That means you don’t have much control over your behavior when your emotions are high. You're probably also not very good at planning for the future.
But if you have psychopathy, you likely have good control over your thoughts and tend to plan out any aggressive acts. Studies show you likely have low levels of anxiety. You also probably don’t react that much to stress or punishment, which means you have what's called low reactivity.
What Causes It?
It’s unclear why some people have antisocial personality disorder or psychopathy. It’s likely that many things play a part, such as:
- The brain. Studies show that people with ASPD may have differences in the brain circuitry that controls behavior. 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.
- Gender. Antisocial personality disorder and psychopathy can happen to anyone but seem to be much more likely in men. ASPD is thought to be three times more common in men than women. But most research into ASPD has focused on men, and the condition may be underdiagnosed in women.
- Upbringing. Neglect, abuse, or an unstable family life during childhood all increase your risk for ASPD.
Brain Differences in Psychopathy
Research suggests that when you have psychopathy, your brain may have physical differences that make it hard for you to identify with someone else’s distress.
One study compared brain MRIs of people with psychopathy to those without psychopathic traits. It showed that people with psychopathy had fewer connections between parts of the brain involved in feelings like guilt or empathy and those responsible for fear and anxiety.
Other research using brain imaging suggests that, when you have psychopathy, differences in the way your brain is wired encourage you to value immediate rewards while ignoring the possible consequences.
Antisocial Personality Disorder Treatment
Antisocial personality disorder is hard to treat. That’s partly because people who have it often don't think they need help. But certain symptoms may show up in childhood. When that happens, if parents get help for their child, they may improve.
There isn’t enough evidence to know how well any kind of treatment works for adults with ASPD. But if someone with this condition is willing to 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 think you have this condition, 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.