Psychopathy vs. Sociopathy: What Is the Difference?

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Over time, increasing numbers of criminal actions, violence, murders, and other crimes in the United States have been linked to perpetrators' psychiatric conditions. This has raised a good deal of controversy, as some believe that mental health has been used as an excuse by certain criminals to commit heinous crimes and avoid legal consequences. Nonetheless, there is some evidence of a relationship between psychiatric conditions and criminal or violent actions.

Psychopathy

Psychopathy is a condition distinguished by abnormal behaviors focused on emotional dysfunction, behavioral issues, and unstable personality traits. Such characteristics include disinhibition, impulsivity, egocentricity, and an inability to show empathy or remorse. Individuals with psychopathic tendencies are likely to mask their personas through superficiality and charm; they can be manipulative and exploitative. Psychopathic traits also include a lack of guilt and a refusal to accept responsibility or accountability for one's actions.

Cause: The cause of psychopathy is unknown; research continues to explore its roots but a combination of genetics, brain abnormalities, and environmental and neurobiological conditions have been implicated as plausible causes in the development of psychopathic traits.

Neuroimaging has been used to study brain structure and performance in individuals with psychopathic traits. Research by Johanson et al. (2020) found reduced gray matter density, neural connections, and orbital cortex inactivity—responsible for processing emotions and empathy—in individuals with psychopathic traits. Additional neuroimaging studies have revealed anterior cingulate and inferior gyrus alterations (also responsible for processing emotions) in persons with psychopathic traits.

Other neuroscientific research suggests that genetic predispositions increase the likelihood of developing psychopathic traits. The predisposition of psychopathy is nearly 50% from parents to offspring and has been linked to abnormal glucose metabolism and opioidergic neurotransmission; some individuals with these neurobiological concerns display psychopathic characteristics and have been involved in violent acts.

Tihonen et al.'s 2020 study showed “robust alternations in the expression of several genes and immune response-related molecular pathways which were specific for psychopathy.” In addition, psychopathic traits were linked to specific upregulation (i.e., activation of the nervous system) and downregulation (i.e., deactivation of the nervous system) genes, which may explain up to 92% of such symptoms. The researchers emphasized that their gene expression findings may be a link to individuals' callousness and inability to express empathy. Further, environmental factors such as abuse, neglect, or exposure to trauma, violence, and other adverse experiences during childhood have been associated with psychopathy. Research has suggested that secondary factors such as inconsistent discipline and parental rejection, and limited positive exposure to socialization may also represent a link to the development of psychopathic traits (Hicks et al., 2012).

Diagnosis: Currently, no formal diagnosis of psychopathy can be made, as it is not recognized as a mental disorder by the American Psychiatric Association (APA). However, psychopathic traits, as well as sociopathic traits, have been cited in diagnostic discussion of antisocial personality disorder (ASPD), as identified in the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In the future, specific assessments may be administered to determine psychopathic behaviors or possible risk for psychopathy in the future. The most common assessments currently used by some clinicians are the Psychopathy Checklist-Revised (PCLR), the Psychopathic Personality Inventory-Revised (PPI-R), and the Hare Psychopathy Checklist (PLC-22).

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Sociopathy

Sociopathy is chracterized by a lack of regard for moral, ethical, or societal boundaries. Individuals who display sociopathic traits may ignore what is considered morally right or wrong, lack emotion, and disregard others. Sociopathy, like psychopathy, is not a formal diagnosis, but sociopathic traits and psychopathic patterns, as well as symptoms of narcissistic personality disorder, can contribute to the diagnosis of antisocial personality disorder. According to the American Psychiatric Association (2013), the "essential feature of antisocial personality disorder is a pervasive pattern of disregard for, and violation for, the rights of others that begins in child or early adolescence and continues into adulthood."

Causes: The causes of ASPD are not fully understood; however, there appear to be genetic, cognitive, and environmental components. Specific behaviors and symptoms may become apparent during childhood but the formal diagnosis cannot be made until early adolescence.

Diagnosis: According to the DSM-5, for a formal diagnosis of ASPD, an individual must exhibit a “pervasive pattern of disregard for a violation of the rights of others at 15 years of age." A minimum of three of the following criteria must be met:

• Failure to conform to social norms concerning lawful behaviors.
• Deceitfulness, lying, using aliases, or conning others for personal profit or pleasure.
• Impulsivity.
• Irritability and aggressiveness.
• Disregard for the safety of self or others.
• Irresponsibility that affects social, academic, or occupational obligations.
• Lack of remorse.

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An individual should complete a psychiatric evaluation to enable a clinician to rule out mental disorders with similar symptoms, such as narcissistic personality disorder, before making a formal diagnosis (American Psychiatric Association, 2013).

Treatment for Psychopathy and Sociopathy

It has been debated whether an individual with psychopathy can be “cured." People with psychopathic traits are generally resistant to treatment, making it difficult for mental health professionals to work with them. However, if they go untreated, there may be a higher possibility that they will engage in exploitative, dangerous, or criminal activity. If ASPD cannot be cured, though, it could possibly be managed. Following are some therapeutic modalities that have been studied:

Psychotherapy (talk therapy) can be beneficial for those with personality challenges, emotional dysfunction, and behavioral issues. Cognitive Behavioral Therapy (CBT) is the standard behavioral therapy for helping individuals alter harmful behaviors and thinking patterns. Dialectical Behavioral Therapy (DBT) can assist with emotion dysregulation and impulsivity by working on an individual's interpersonal skills and distress, and helping them adopt mindfulness practices. Schema therapy may also be used, to focus on specific patterns in behavior and cognition by helping individuals understand such themes (known as schemas) and change them to improve emotional and social performance. And psychodynamic therapy can be used to explore unconscious motives and conflicts that may be among the underlying causes of antisocial behavior.

There are no specific medications approved to treat psychopathy or sociopathy. However, medications can be prescribed to treat mood or behavioral symptoms such aggression, impulsivity, irritability, or emotion dysfunction—as well as comorbid psychiatric conditions such as anxiety and depression. Research suggests, though, that behavioral interventions can be just as beneficial as medicinal treatment. Anger management, impulsivity, and social skills training may be effective, especially when using reward-based programs to reduce psychopathic symptoms.

Nonetheless, it must be understood that there can be significant challenges in working with individuals who display psychopathic or sociopathic traits. Lack of insight may be the most common issue, as such individuals often lack awareness about their personality challenges, and so they often ignore or refuse to recognize the need for treatment. Also, they can be manipulative, attempting to control professionals or treatment. Lastly, there tend to be significant relapse rates due to the assiduous nature of ASPD.

Early intervention is key to effectiveness of managing antisocial symptoms. Promising neuroscientific studies are focusing on the neurological implications of psychopathy and sociopathy and could lead to new treatment programs. Currently, personalized treatment programs from a multi-faceted or individualized approach is key in improving outcomes. Establishing structured environments and having a solid support system is the start. Working with individuals who possess these traits during childhood and adolescence is crucial and incorporating programs that are centered on empathy, moral reasoning, and prosocial behavior and insight can be the difference between an individual having a promising life or becoming a menace to others.

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