The terms “psychotic” and “psychopathic” are used a lot in popular culture, sometimes interchangeably. While they both refer to serious mental health conditions, they aren't really medical terms. Doctors and mental health experts don't use either of these terms because they oversimplify very complex conditions.
Instead of saying that people are "psychotic," experts say that a person has psychosis. Psychosis isn't a condition in itself. It's a set of symptoms that show a person has disruptions in their thoughts and perceptions that make it hard for them to tell what is real and what isn't. It's usually brought on by a mental health condition, medical condition, or substance abuse or withdrawal.
And "psychopath" isn't a mental health condition, either. Psychopathy is probably a neurodevelopmental disorder that makes it difficult for the person to have empathy for other people. Neurodevelopmental conditions are changes in the way a person's brain develops that cause them to have disabilities in thinking, communication, behavior, or motor skills.
Read on to learn a bit more about what experts think psychosis and psychopathy are and what may cause them.
What Is Psychosis?
Psychosis isn't an illness. Rather, it's a cluster of symptoms that make it hard for the person having them to tell what's real and what isn't. Many people who have psychosis can't perceive or understand that they are having an episode. Psychosis can be brought on by a number of psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. You may also have symptoms of psychosis with some mood or substance use disorders.
Psychiatrists use the Diagnostic and Statistical Manual, fifth edition (DSM-5) to help them figure out who has psychosis. There's no hard definition of psychosis because it can show up in many different ways. But it's broadly a cluster of abnormal thinking or perceptions in the following ways:
Delusions. These are false beliefsthat the person can't tell are false. Even showing them evidence that their belief is wrong won't convince them. Such beliefs can be "bizarre," which means they are completely outside the realm of possibility. Or, they may be "non-bizarre," which means they are plausible but still not true. There are a few types of delusions, such as:
- Persecutory delusions, which are the most common type people have. This is a belief that others around you are "out to get you."
- Referential delusions are beliefs that things in your environment are directing messages to you. For instance, you may believe that the people on the TV are talking directly to you.
- Grandiose delusions are over-the-top beliefs about your own abilities.
- Erotomanic delusions are beliefs that other people, even people you may not know, are in love with you.
- Nihilistic delusions are beliefs that a major catastrophe is about to happen even when that's highly unlikely.
- Somatic delusions are beliefs that something is biologically wrong with you or other people around you.
Hallucination s. These are things you see, hear, smell, taste, or feel that other people can't experience.
Disorganized thought. This usually shows up through your speech and communication patterns. People with organized thoughts will talk things through in a mostly logical or goal-directed way. If you have disorganized thought, you may make up words or phrases that don't mean anything to others. Or you may speak in a "word salad," with an incoherent jumble of words that don't seem to belong together. You may not be able to give an answer to a direct question without including excessive, unnecessary, or irrelevant details. Or you may jump between unrelated or only loosely related ideas.
Disorganized behavior. This is behavior that doesn't seem goal-directed and may mean you can't function on a day-to-day basis. You may have unpredictable or inappropriate emotional responses to things that happen around you. You may not be able to control your impulses. You may do nonsense actions that are socially inappropriate. Some people have catatonic behavior, which is when you stop moving or responding to your environment or you may wander aimlessly.
Negative symptoms. This is a decrease or loss of your ability to function normally. It often looks like a depressive episode. You may stop responding emotionally to others around you. Or you may stop speaking or only speak in a monotone, without varying the pitch, loudness, or length of your speech. You may lose the ability to concentrate or take pleasure in any of your activities.
Having a psychotic episode can be very scary, isolating, and confusing. No matter what caused it, there is a risk that the person may hurt themselves or others when they're having an episode. But the vast majority of people who have psychosis are not violent. Most people with a psychotic disorder are more likely to hurt themselves than other people. Unfortunately, the rate of suicide is about 5% in people with schizophrenia.
What Causes Psychosis?
Psychosis is common in many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. For instance:
Schizophrenia spectrum and other psychotic disorders, including:
- Schizophrenia
- Schizoaffective disorder
- Schizophreniform disorder
- Schizotypal disorder
- Brief psychotic disorder
Some mood disorders, such as bipolar disorder and major depressive disorder
Medical conditions, including:
- Alzheimer's disease and other forms of dementia
- Brain infections, like encephalitis or meningitis
- Stroke
- Severe head injuries, such as a concussion or traumatic brain injury
- Autoimmune conditions, such as Addison's disease, Cushing's disease, Hashimoto's thyroiditis, lupus, and multiple sclerosis
- Postpartum psychosis, which is related to postpartum depression
- Stroke and other neurological conditions
- Vitamin deficiencies, such as a lack of thiamine or vitamin B12
Substance abuse or withdrawal, including from alcohol, prescription medicines, or recreational drugs like marijuana, LSD, or amphetamines
Having a traumatic experience, even if it was in the past
Extremely high levels of stress and anxiety
What Is Psychopathy?
"Psychopathy" is a complicated mental health phenomenon that professionals are still working to understand. It isn't an official mental health diagnosis; there's no category for it in the DSM-5. Psychopathy was included in the first two editions of the DSM, then replaced with antisocial personality disorder (ASPD) in the third edition. But not everyone who has ASPD has psychopathy. In fact, only about 33% of people with ASPD also meet criteria for psychopathy. There are a lot of reasons why a person may have antisocial behaviors. So, psychopathy has been removed from the DSM.
The closest thing to "psychopathy" in the DSM-5 is conduct disorder with limited prosocial emotions. But this diagnosis is only for people who are younger than 18 years.
Currently, psychopathy may be best understood as a neurodevelopmental disorder that's marked by:
- Reduced empathy and remorse
- A bold, daring personality
- Trouble inhibiting behaviors
- Aggressive or violent behavior (sometimes)
Some mental health professionals think that the traits we call psychopathy are on a spectrum, which means that they vary in severity across all people. Experts think that about 1% of people probably have psychopathic traits. Some people may show mild psychopathic traits, while other people have severe psychopathic traits. But not everyone with psychopathic traits is violent or aggressive.
What Causes Psychopathy?
Mental health experts think there's likely no one cause of psychopathy. Rather, it's probably caused by a combination of things. This is why experts think it's likely a neurodevelopmental condition. A neurodevelopmental condition is one that's marked by disabilities in thinking, communication, behavior, and/or motor skills that may be caused by changes in the way your brain develops.
Takeaways
"Psychotic" and "psychopathic" are slang terms for a couple of serious mental health conditions. Neither term is an actual medical term or diagnosis. And they likely aren't related, except that they involve differences in the way you think or perceive things. People who have psychosis are having challenges in their thought processes that make it hard for them to know what's real. People with psychopathic traits likely have changes in their brain that make it hard for them to feel empathy for the people around them. People with psychosis and people with psychopathic traits have the potential to be violent or aggressive, but, in general, their triggers for violence are pretty much the same as for people without these conditions. In either case, using substances like alcohol or recreational drugs increases their risk of violence.
Psychotic vs. Psychopathic FAQs
Is psychotic the same thing as sociopathic?
Mental health professionals don't use the terms "psychotic" or "sociopathic." Both terms are used in popular culture to describe sets of traits that are related to antisocial personality disorder (ASPD). But they aren't the same thing. Check out How Sociopaths and Psychopaths are Different to learn more.
