Archive for July, 2007

Psychopath vs. Sociopath

July 16, 2007

I’m often asked about the difference between a psychopath and sociopath, and it’s difficult to respond because the answer is complex. Many people mistakenly believe the two terms are interchangeable, which is no surprise since both politics and religion have influenced the long evolution of the concept of psychopathy. Thus, I want to discuss why we haven’t designated a single label for a certain type of personality disorder.

 

It was Theophrastus, a student of Aristotle, who first described this type of person, referring to him as the Unscrupulous Man. He was a liar, cheat, and con artist, without compunction about harming others for his gain. Thus, something was morally wrong with him. (Female psychopaths had not yet come into the picture.)

 

While psychopathy was the first personality disorder that psychiatry formally recognized in the nineteenth century, it wasn’t easy to crystallize a workable concept for analysis or research. Pinel, a French psychiatrist, used a phrase during the early 1800s that translated as “mania without madness.” He described impulsive people whose actions had negative consequences for themselves as well as others, yet they were fully aware of what they were doing. It seemed a mystery.

           

In America, Benjamin Rush designated the same behavior as moral derangement and observed that such people develop socially disruptive behavior early in life. In his opinion, they were bad not ill. An English physician, calling it moral insanity, viewed psychopathy as an emotional disorder: These people had criminal tendencies that were not deterred by the idea of punishment.

 

The actual term, psychopath, first showed up in Germany, during the latter part of the 19th century, but it also covered certain biological disorders, and by the early part of the twentieth century, “constitutional psychopathic inferiority” had become a catchall term for most mental and physical defects. Then brain damage and physiological conditions were placed in another medical category. The next step was to remove ‘constitutional’ from the classification, which still left the unworkably broad ‘psychopathic personality.’ For the percentage of people not psychotic or psychoneurotic who nevertheless caused distress in the community, the most common designation was psychopath.

 

More psychiatrists worked out ways to refine the concept, but it wasn’t until 1941 that the notion of a psychopath was ably crystallized. Hervey Cleckley published The Mask of Sanity, in which he offered 16 distinct criteria for diagnosis, including hot-headed, manipulative, irresponsible, self-centered, shallow, lacking in empathy or anxiety, and likely to commit more types of crimes than other offenders. They are also more violent, more likely to recidivate, and less likely to respond to treatment.

 

Now, what about the sociopath? As the concept of psychopathy continued to evolve, the emphasis on assessment in psychiatric circles moved away from traits and toward specific behaviors. To reflect this, some older concepts were renamed. In 1952, in the psychiatric nomenclature, the word ‘psychopath’ was officially replaced with ‘sociopathic personality,’ and both terms were often used interchangeably under the heading of ‘personality disorder.’ Then with the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1968, ‘sociopathic personality’ yielded to ‘personality disorder, antisocial type.’ Such people were impulsive, guiltless, selfish, callous, and unable to learn from experience.

 

Twelve years later, the DSM-III introduced a list of explicit criteria for psychopaths, but calling it Antisocial Personality Disorder (ASPD). The criteria emphasized the violation of social norms rather than personality traits. However, many researchers were dissatisfied with this new approach because it had no utility.

 

During the seventies, some researchers ignored the DSM and devised better diagnostic assessments for the traditional notion of a psychopath, as Cleckley had viewed it. Robert Hare and his colleagues in Canada devised the Psychopathy Checklist (PCL-R), with 20 items covering both traits and behaviors. Yet most mental health professionals in the U.S. stuck with the DSM, as if ASPD meant the same thing. But it didn’t. ASPD is a broader category, inclusive of people who would not qualify on the PCL-R as psychopaths, and while some psychopaths might also be diagnosable as ASPD, it would not apply to all people diagnosable as psychopaths. Thus, the terms refer to overlapping but nevertheless different categories of people. (Try saying all of that five times, fast.)

 

Researchers who followed the traditional idea viewed psychopathy as a disorder characterized by such traits as lack of remorse or empathy, shallow emotions, manipulativeness, lying, egocentricity, glibness, low frustration tolerance, episodic relationships, parasitic lifestyle, and the persistent violation of social norms. According to Hare, “Psychopathy is one of the best validated constructs in the realm of psychopathology.”

 

Without getting the complex politics surrounding the different diagnostic systems, people who were unaware of the need for precision and accuracy for research and assessment adopted a preference for using either ‘psychopath’ or ‘sociopath’ and came up with their own workable definitions. In other words, things got a little sloppy. I’ve even seen writers use the term ‘sociopath’ but rely on the criteria specific to psychopathy. However, ‘sociopath’ has a different connotation for people who recognize the PCL-R as the best diagnostic assessment.

 

Which brings me back to the original question: the difference between a psychopath and sociopath. If you subscribe to the Hare criteria for a psychopath, then you see the conning, manipulative narcissistic liar and user as a psychopath, as long as he or she is completely lacking in remorse or empathy. The sociopath, however, is capable of guilt, caring, building relationships, etc., but only within a certain context. He or she will have loyalties to a specific group but not to society at large. They care nothing for social norms and will break them with impunity, if it serves their purpose. So, on the surface, they look just like psychopaths. However, they might genuinely feel remorse over harming someone within their group or family. They will have a moral code of behavior specific to that context: they might not lie, exploit, or manipulate within the group. Thus, they exhibit psychopathic behaviors in certain contexts but not all.

 

See? I warned you the answer was complex. Does it really matter? In a practical sense, yes. The PCL-R has been proven to be the best predictor of recidivism in criminal populations, and the best predictor of future criminal diversity and brutality. For those who are working with (or writing about) this type of person, grasping their motivational construct can be crucial to understanding what they’re all about…and what they might do in the future.  As far as I know, there is no equivalent diagnostic tool for a sociopath.

(First posted on “In Cold Blog”)

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