Sociopathy or Psychopathy? What the Heck?

If you are confused about how sociopathy is different from psychopathy, it’s not you! The entire mental health field is confused, too. For the life of me, I cannot understand why the high who-haws of psychiatry can’t get this act together.

These terms are variants of the official diagnosis, Antisocial Personality Disorder, but many psychiatric professionals prefer common-speak. Here, my focus is on presenting a working definition of a sociopath, when to use the term psychopath, and some conditions which underly them both. Be aware—this is my rendering. Others may slice the cake a little differently.

One might wonder why these topics are in such use today when research estimates the prevalences are low. While the ratio of sociopaths in incarcerated populations is 15-25%, it is only 3-4% in the general population (up to14 million people). Studies find the prevalence of psychopaths at 0.5-1% in the general population (almost 3.5 million people). A small number of people cause society a lot of distress.

The Basics of Sociopathy

A person displaying sociopathy (so-ci-au´-path-y) will have consistent, predictable patterns of relating to others in three categories:

Relationships:

• Self-centeredness

• Pathological lying

• Manipulation; conning; engages in transactional relationships

Emotions:

• Shallow emotions

• Lack of empathy, guilt, or remorse; callousness

Behavior:

• Doesn’t take responsibility, resorts to blaming others

• Impulsive; stimulation-seeking, risk-taking

• Poor anger control

• Engages in unethical and antisocial behavior

In my use, these are the hallmarks of a sociopath. A separate checklist that is not part of the psychiatric diagnosis manual but is used by researchers in studying psychopathy is Robert Hare’s Psychopathy Checklist (PCL-R¹). Using the above traits, and with a few tweaks here and there, it distinguishes a psychopath by adding these other behavioral disturbances: sexual promiscuity, many short marital relationships, early acting out (such as animal torture and fire-setting), juvenile delinquency, and engaging in versatile crimes. Except for youthful animal torture and fire-setting—behaviors which always stand out—these other traits, on their own, don’t impress me as a clinician. They occur too often to be meaningful in getting a feel for the extremes.

How Does Sociopathy Morph into Psychopathy?

Sociopaths will use and abuse others to obtain what they want without reservation: it’s more or less just business to them. Machiavellian is the term we use to describe patterns of manipulation, exploitation of others, a cynical disregard for morality; a person who is strategic, calculating, and focused on personal gain, often at the expense of others.

In my view, a psychopath is everything a sociopath is, except he or she has a significant added dimension: sadism². This is a person who enjoys conning, humiliating, blackmailing, hurting, or killing other living things. It is first and foremost about dominance at any cost.

What about punishment? A sociopath may or may not alter his choices when rewarded or punished. On the other hand, a psychopath must satisfy his urges. They are fundamental predators: serial killers, rapists, arsonists, etc. Torture on many levels is the currency. This person, as defined in my scheme, doesn’t “reform.”

Psychopaths Have a Favored Hunting Ground

Serial rapists and serial killers have come to define the criminal space for those attracted to sensationalism (although serial killers account for only 1% of all murders). In a previous essay, “Killer Couples: Folié a Deux,” I included Paul Bernardo, the Canadian serial rapist, torturer, and killer who worked his capers with his wife, Karla Homolka. Bernardo scored 35 out of 40 on the Hare PCL-R. He is more or less the prototype of a psychopath, showing interest in the hunt for victims.

There are other, more everyday psychopaths who don’t kill. Some ply their trade as domestic violence perpetrators. Unlike the garden-variety abusers who violate out of abandonment fears, this man hurts, humiliates, blackmails, or even tortures his partner as a form of amusement. This would include some stalkers and revenge porn posters. The ultimate opportunist, he prefers not having to hunt for his victims.

Power, celebrity, and money are the worst breeders of the pathology, often keeping them out of reach of the law. In these cases, the criminal doesn’t need to hunt for his victims —they arrive at his front door, hoping some of his promised fairy dust will land on them. I see Harvey Weinstein as a perfect example of a sociopath sexual predator. The sociopath Alexander brothers, wealthy New York realtors, worked a second gig as sex-traffickers and folié a deux rapists. I see R. Kelly and Sean Combs as unique examples of psychopath sexual predators, Combs perhaps a murderer. There are others I could name that you would recognize.

How Psychiatric Professionals Cope with This Level of Pathology

Encountering such patients in the mental health field causes one’s emotional responses to blast through the compassion that professionals ordinarily bring to their work. When a client, patient, or defendant is a malignant narcissistic (the more severe sociopath) or is sadistic, it is common to hear the dismissive response: “That person just has a piece missing.” No medication exists to bring about empathic feelings in such a person. Nor, obviously, can he be taught or reformed through reward and punishment.

It is also possible that this pejorative view is a defense for our failure to develop effective therapeutic techniques which would change such a person and implies we have given up on him. Still, it is a common coping response to which we resort, and I have done so my share of times.

Indeed, the lack of empathy and remorse poses the biggest challenge. Where callousness will drive a sociopathic personality, that absence of empathy plus the need for torture-based stimulation drives the psychopathic one. Think about instances of serial murderers who, when asked why they first killed, reply: “I wanted to see what it was like to kill someone.”

The “Cause”

Genetic. Scholars tell us that children of individuals with Antisocial Personality Disorder are at higher risk of developing a similar pattern. The gold standard of research—twin and adoption studies—provide heritability estimates for antisocial behavior ranging from 40% to 50%. It is not unusual to find adopted children of imprisoned biological parents grow up to be criminals, themselves, even if their adoptive environment from an early age was normal.

Environmental. When my job was to examine men charged with capital murder, I soaked up every bit of information about the software of his life in order to flesh out his road map to murder. You’d be surprised how much documented information exists over the life of a typical 21-year-old murderer. And I found that this was exactly the point. The normal young man has no such “file” that details his fateful life.

When we come upon behavior without the precursor of parental sociopathy, we are likely to conclude that factors in the environment are driving the behavior. These are the major kinds of experiences, when occurring together, that can produce sociopathic behavior, not necessarily a sign of the personality structure:

· the range and depth of ways caregivers neglect and abuse children

· impaired attachment

· impoverished and criminal environments

· modeling by “successful” leaders who nurture their followers into the criminal mindset (for example, street gangs and the mob).

This is the place where we must demarcate between sociopathic behaviors—which can be produced by pernicious environments—and the hardware of genes or neurology that produce a mostly unchangeable picture. It is a variation of the difference between “states” and “traits.”

Neurological. It is instinctive to conclude that certain neurobiological elements found in the sociopath—the notorious lack of empathy, shallow emotions, early risk-taking, and over-stimulation to anger—indicate something in the hardware is off. What if it were largely a brain-based syndrome?

But wait! Here comes the point where I greatly unsettle our easy labels and judgments about sociopathy and even psychopathy. Advancements in brain scans (fMRI and PET) have added in significant ways to our understanding³. These data don't tell us if their remarkable abnormalities are causes, consequences, or simply correlates to harmful environments, but that doesn’t mean such knowledge can be minimized. This is what scans of diagnosed sociopaths have revealed:

• Smaller and less active amygdala—the part of the brain which processes fear and empathy—promoting emotional coldness and remorselessness; recognition of others’ expressions of fear and sadness are deficient, while recognition of their expressions of disgust and anger remain normal (often received as being disrespected)

• Reduced activity in the prefrontal cortex implies challenges in regulating emotional responses and impulsivity, increasing risk for aggression to get what he wants, particularly when combined with lack of empathy

• Impaired connectivity between the prefrontal cortex and the amygdala, suggesting poor ability to assess the consequences of choices

• Reduced gray matter volume suggests dysfunction in more intricate thought processes, such as moral reasoning and interpreting social cues

• Increased activity in the brain’s reward systems which promotes risk-taking and desire for immediate gratification, almost as if riskiness is calming

In other words, this is the picture of a brain plagued by areas with reduced volume, impaired connectivity, too little or too much activity. A brain that came with substandard wiring. One ill-equipped to function in a stressed environment. If you are reading this essay, you would have no way of knowing, personally, what a life with this brain is like.

How Brain Scans Have Stressed Our Knowledge Base

I do not forget there is, indeed, a bottom line here: sociopathic and psychopathic behavior is consistent, harmful, dangerous, and resistant to treatment. This means we must always keep our guard up to protect ourselves.

On the other hand, the much more complex picture of how abnormal brains interact with environmental challenges should keep us humble. It places us in a deeply challenging position in ascribing full intention to those with this nefarious picture, in particular, a subset of those who commit capital murders.

Think of an 11-year-old boy who is faced with a harsh set of circumstances—perhaps an abusive parent or a sociopathic one, living in a damaging environment—and then consider what a poor set of tools his brain offers him. Why are we surprised when, a few years later—and without meaningful intervention—he crosses the line? By the time he is an adult and commits a horrific crime, often before he is 24 years old, he is no longer fully human to us.

The critical question is: if their brains don’t work anywhere near properly, how do we extract accountability from them? The answer to this question eludes me. I would never suggest they not be incarcerated—some perhaps, for life—but under such circumstances, can state-sanctioned execution possibly be a moral answer?

The Costs of Truth in Seeking Justice

I have begged defense attorneys to petition the court for money to scan some of our defendants. It was always a losing cause. It seems judges don’t want to open the door to such a rise in trial costs—both costs to the taxpayer, as well as the one that threatens the status-quo of our criminal justice system.

Brain scans and what we know about them are not junk science. I am willing to bet that if we did routinely scan those who show such brain irregularities, it would completely dislodge the death penalty system, if not many verdicts of life without parole. In this way, we are a still a long way from justice.

Capital murder trials present an exquisite laboratory to test the theory of the “why” of human behavior. The dilemma lies in how to place the “causes” of criminality in relation to one another: 1) genes, 2) neurology, and 3) environment. Then there is the thorny question of 4) one’s “free will.” In my court testimony, I aimed to worry the jury with the first three stories so that they would have more trouble resorting to the simple-minded fourth explanation.

I have the same emotions as everyone else, including the desire to view such people with complete disdain. However, with this kind of research beating down the door of our previous understanding, I am left wondering if we may have lost our own capacity for compassion. Surely, we had it easier when we thought our only choice was between the “bad seed” theory or the “poor child” theory. Science sends me on a forever search on this one.

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Next week’s newsletter is as good a place as any to slide into the topic of the day: How sociopaths become leaders and how people become their followers. Be sure to take a breath.

Citations

¹ Hare, R. D. (2003). The Hare Psychopathy Checklist–Revised (2nd ed.). Toronto, ON: Multi-Health Systems.

² Paulhus, D. L. (2014). “Toward a taxonomy of dark personalities.” Current Directions in Psychological Science, 23(6), 421–426. https://doi.org/10.1177/0963721414547737.

³ Gregory, et al. (2012). “The Antisocial Brain: Psychopathy Matters: A Structural MRI Investigation of Antisocial Male Violent Offender.” Archives in General Psychiatry, September 2012, pp. 962-972.