Buzz
They're portrayed in movies and discussed in the news. Often calculating, charming, and ruthless. But are they psychopaths or sociopaths?
If you turn to pop psychology for answers, you’ll find many contradictory viewpoints. Some argue that psychopaths are born, while sociopaths are shaped by harsh childhoods and traumatic environments. Others contend that 'sociopath' is merely a new term for 'psychopath.' There’s no definitive agreement.
This confusion might have a reason: neither 'psychopath' nor 'sociopath' is an official diagnosis. They’re terms used for individuals displaying 'pathological' traits. In the U.S., these traits fall under the diagnosis of antisocial personality disorder (APD), according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The World Health Organization refers to this as dissocial personality disorder (DPD).
APD and DPD are essentially identical. To be diagnosed with either, an individual must demonstrate a 'disregard for and violation of others’ rights.' The DSM-5 outlines 6 main criteria [PDF]:
1. Personality dysfunctions, including a lack of remorse, self-centeredness, 'goal-setting driven by personal pleasure,' and an inability to build mutually intimate relationships;
2. Pathological personality traits, such as manipulativeness, deceitfulness, callousness, aggression, irresponsibility, impulsivity, and a tendency toward risk-taking;
3. These personality traits and dysfunctions must be persistent and stable over time;
4. These traits and dysfunctions must be atypical for the person’s developmental stage (many toddlers could be considered psychopaths) or cultural context;
5. The individual’s personality and behavior cannot be attributed to a medical condition or substance misuse; and
6. The individual must be at least 18 years old—this is a debatable criterion, as many psychologists believe that children can begin exhibiting signs of APD at an early age.
One commonly used 'psychopath test' is the Hare Psychopathy Checklist-Revised (PCL-R), a 20-question assessment used by researchers, clinicians, and the legal system to evaluate antisocial behaviors. (You can view the list to assess yourself, or your boss, here.)
It’s important to distinguish between psychopathy and psychosis. Although the terms sound alike and are often used as insults, they are vastly different. Psychopathy refers to a personality disorder, while psychosis involves a loss of contact with reality, significant personality shifts, and difficulty functioning. The two conditions are generally separate; most individuals with APD will never experience psychosis, and vice versa.
The exact cause of APD remains unclear. Some researchers differentiate between primary and secondary psychopathy, each with distinct causes [PDF] and manifestations. While traumatic childhoods and challenging home environments can contribute, there is also a noticeable physiological component. A genetic variant known as MAOA-L has been linked to an elevated risk of violent and aggressive behaviors, and brain scans of individuals with APD show low activity in areas associated with empathy, morality, and self-regulation.
This doesn't imply that everyone with APD is violent, nor does it mean they are inherently bad people. Many individuals with APD remain undiagnosed because they lead successful, ordinary lives.
For evidence, consider neurologist James Fallon: Fallon has spent decades studying the brain's role in what’s known as psychopathy. His research has contributed to identifying distinct brain patterns in people with APD. In 2005, while examining brain scans of individuals with APD, as well as those of people with depression and schizophrenia, he had a stack of scans from his own family, taken as part of an Alzheimer’s study.
'I reached the bottom of the stack and saw a scan that was clearly abnormal,' he recounted to Smithsonian. The brain in the image appeared to belong to a psychopath—but the scans at the bottom of the pile were from his family. Stunned, he decided to check the code on the scan to figure out whose brain it was.
It was his own brain.
Fallon was in disbelief. His first reaction was to question his own research, thinking that low brain activity in certain regions might not actually be linked to APD. Then, he spoke to his family. 'Duh,' they responded. 'Of course you’re a psychopath.' His mother, wife, and children had always recognized and lived with his personality traits.
Fallon underwent additional testing, which confirmed the diagnosis. Over time, he came to realize that he had always known. Throughout his life, he wrote in an op-ed for The Guardian, strangers often remarked that he seemed 'evil,' and while he was never physically violent, he acknowledged having a cold side. He had placed others in harm's way. He also admitted to being 'kind of an a**hole,' as he confessed to Smithsonian.
'I’m excessively competitive,' he shared with the magazine. 'I won’t let my grandchildren win at games... I’m aggressive, but my aggression is more psychological. I’d rather win an argument than physically fight someone.'
Fallon attributes his relative success to having grown up in a healthy, stable environment with ample support. He was raised in a loving home, which, he believes, may have helped him tame some of his darker impulses.
Currently, there is no cure for APD. Finding effective treatment options has proven difficult, partly because individuals with APD tend to be comfortable with their personality traits and lack motivation to change. Nonetheless, some, like Fallon, are determined to improve at least a little.
'After discovering all of this and reflecting on it, I’ve made a conscious effort to alter my behavior,' Fallon told Smithsonian. 'I’ve been more mindful of doing what’s considered 'the right thing' and taking others' feelings into account.'
