Psychopathic, Sociopathic, or Antisocial Personality?

Psychological traits commonly attributed to tyrants like Josef Stalin, Adolf Hitler and Saddam Hussein often include those included under the umbrella term Dark Triad. This constellation of traits includes elements of narcissism, Machiavellianism, and psychopathy. Psychopathy is often the first one people consider when trying to understand tyrants’ actions and outlook, and when they try to make sense of the suffering tyrants cause.

According to the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the DSM–5, psychopathy is another term for Antisocial Personality Disorder. The prevalence rate of this disorder (which the DSM-5 authors consider the equivalent of sociopathy) is between 0.2 percent and 3.3 percent.

A good indication of how much we still have to learn about the nature of psychopathy is the confusion that surrounds the labels different people apply to this disorder or personality type, depending on your view of its nature. Psychopathy expert Robert Hare, Ph.D., asserts that most individuals with Antisocial Personality Disorder are not psychopathic. Psychopathic individuals, according to Hare and other academic researchers, have core features that are not included in the current diagnostic criteria for Antisocial Personality Disorder, including lack of empathy. The prevalence rate of psychopathy is estimated to be about 1 percent.

In the early part of the 20th century, the word “psychopath” described not only individuals who lacked a conscience but included others who had additional mental or personality disorders, such as weak-mindedness and depression. Today, the implications of the term are more refined.

“Psychopathy is a developmental disorder marked by emotional deficits and an increased risk for antisocial behavior,” R. James R. Blair, Ph.D., explained in his article “Psychopathy: cognitive and neural dysfunction” in Dialogues in Clinical Neuroscience. “It is not equivalent to the diagnosis Antisocial Personality Disorder, which concentrates only on the increased risk for antisocial behavior and not a specific cause—i.e., the reduced empathy and guilt that constitutes the emotional deficit.”

Some mental health care providers use the word sociopathy when referring to Antisocial Personality Disorder. Others use sociopathy to describe a condition somehow different from psychopathy. There are a couple of reasons the label sociopath gained a foothold firm enough to create confusion in psychiatry and forensic psychology, which is still struggling for agreed upon definitions. One reason the label “sociopath” lingers alongside that of “psychopath” is because the American Psychiatric Association used the diagnosis of Sociopathic Personality Disturbance from 1952 to 1968.

The term “sociopath” became popular starting in the 1930s in part because it conveys the impression that the antisocial symptoms can be traced to social influences rather than to biological ones. (In the past, social influences in criminal behavior were considered more important than biological influences. Today, the most popular explanation is that both influences can contribute to criminal behavior, and very likely, to the development of psychopathic behavior).

The persistence of the terms sociopath and psychopath reflects the need for a better understanding of subtypes of psychopathic personalities. Some people think of sociopathic persons as “pseudo-psychopaths,” or as a subtype of psychopathy with less severe psychopathic traits than more “hardcore” psychopathic individuals.

Also, the use of the word sociopath would be one way to avoid confusion between psychotic (which makes a person legally insane) and psychopathic (which makes a person legally sane). Sadly, there is no general agreement that the label sociopath reflects these distinctions. Academic researchers, in contrast to many clinicians, favor the term psychopathy almost exclusively.

Confessions of a Sociopath author M.E. Thomas chose to describe herself as a sociopath. Thomas doesn’t have much patience with psychologists who, she says, “quibble ad nauseam on the psychological classification of sociopathy.” But perhaps she should if she wants to understand herself a bit more. Jennifer Skeem, Ph.D., one of the psychologists Thomas quotes in her Biographile piece, “Little Do We Know: 5 Myths About Sociopathy, Debunked,” co-authored a paper in which she said: “…the definition of psychopathy itself — what it is, what it is not — is one of the most fundamental questions for psychological science.”

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A version of this column originally appeared on the website “Biographile, Discover the World Through Biography and Memoir.” It was adapted from the book Murderous Minds: Exploring the Criminal Psychopathic Brain: Neurological Imaging and the Manifestation of Evil by Dean A. Haycock.