Psychotic vs. Psychopathic: What’s the Difference?

Medically Reviewed by Smitha Bhandari, MD on March 13, 2023
2 min read

The terms “psychotic” and “psychopath” are used a lot in popular culture, sometimes interchangeably. But they refer to two different mental health problems, both of them serious.

If someone is psychotic (or has what doctors call psychosis), their mind is losing its grip on reality. A psychopath is someone who isn’t able to feel for others and may act in reckless and antisocial ways.

Psychosis is often a symptom of another condition, while psychopathy is a personality trait. Less than 1% of people are believed to be psychopaths. Most are men, but it can happen in women, too.

It’s when something affects how your brain understands the world around you. It’s sometimes called a psychotic episode.

  • Psychosis can make it hard to think or speak in a way that makes sense to others. It can make you see, hear, or feel things that aren’t there (a hallucination).
  • It may involve delusions, meaning you believe something that’s not true even when the facts all point the other way. For example, you might be convinced that someone is trying to hurt you or that someone else is controlling your thoughts.
  • If you’re having a psychotic episode, you might be depressed or anxious or have trouble sleeping. It also can make you feel frightened, withdraw from others, or stop taking care of yourself.

About 3 people in 100 will have some sort of psychotic episode during their lifetime. These can be frightening and confusing, but getting medical help quickly when it happens can help prevent further problems.

The best-known causes of psychosis are mental illnesses like schizophrenia or bipolar disorder, but several other things can bring on a psychotic episode or make you more likely to have one:

  • Illnesses that attack your brain and nerves, such as Alzheimer’s disease, Parkinson’s disease, or epilepsy
  • Traumatic events like a violent attack
  • Some drugs, including marijuana, LSD, or amphetamines
  • Going a long time without sleep


People who are psychopaths don’t live by social rules or expectations. For example, they might:

  • Lie often
  • Have an inflated view of themselves
  • Not be able to control their impulses
  • Not feel guilt or regret for actions that hurt others
  • Try to manipulate other people

Psychopaths often come across as charming and engaging at first, but they may become demanding or physically aggressive. Some have early behavioral problems or commit violent crimes.

Researchers aren’t sure what causes psychopathy.