Psychopathy and Sociopathy - the saga continues and becomes even more complicated!

In a previous newsletter I talked about the ongoing confusion around the differences between a psychopath and a sociopath.   
Often, even mental health professionals use these terms interchangeably – as though they are talking about the same thing.  However, to add to the confusion, many people also believe that Psychopathy is the same thing as Antisocial Personality Disorder, one of the most common psychological issues found in the residents of our prisons!

So let’s have a look at Antisocial Personality Disorder or ASPD and how how we get to this point of confusion…after all, we as mental health professionals should be adequately trained to know our ‘paths’ when we encounter one.

In the field of Psychology, we appear to have a clear definition and consistent measures of what ‘antisocial’ behavior is. 
However, Psychopathy is more than just being ‘antisocial’ -  part of the confusion comes from the different measures of the non-antisocial personality traits seen in psychopathy, which then gives rise to different conceptions of what it means to have ‘psychopathy.’

The problem may have simply arisen because most people with psychopathy and sociopathy will fit the criteria for and often have a diagnoses of, ASPD.  

Antisocial personality disorder is a condition in which a person's ways of thinking, perceiving situations and relating to others are dysfunctional — and destructive with little regard to others or to society.

Antisocial personality disorder signs and symptoms may include:
                          * Disregard for right and wrong
                          * Persistent lying or deceit to exploit others
                          * Using charm or wit to manipulate others for personal gain or for personal pleasure
                          * Sense of superiority and exhibitionism
                          * Recurring difficulties with the law
                          * Repeatedly violating the rights of others by the use of intimidation, dishonesty
                            and misrepresentation
                          * Hostility, significant irritability, agitation, impulsiveness, aggression or violence
                          * Lack of empathy for others and lack of remorse about harming others
                          * Unnecessary risk-taking or dangerous behaviours
                          * Poor or abusive relationships

It might seem clearer now that we can see that the symptoms of ASPD seem to mirror those of psychopathy and sociopathy.  

One of the key differences however, is that to have a diagnosis of ASPD, a person must have been diagnosed with a condition known as Conduct Disorder prior to turning eighteen years old. 

A clinician must have evidence of a clear and obvious historical pattern of destructive behaviours and ongoing disregard for others.

A person who presents as psychopathic may never meet this criteria because they have had the ability to regulate and modify their behaviour for their own gain or benefit.  Indeed, a ‘good’ psychopath, can manipulate his or her way through an entire lifetime without ever having a formal diagnosis:

These are what we refer to as ‘successful’ or ‘functional’ psychopaths and they live amongst us in all shapes and sizes.

Clinicians continue to debate and argue how we can measure or quantify such a construct if we never truly know the historical and clinical history of such individuals.  

Is it ethical or fair to label people with diagnoses that would essentially label them as pariahs of society when we don’t have extensive, clear consistent evidence of what it means to be any of the paths?

While ASPD is a formal diagnosis found in the manual of psychological and psychiatric disorders (The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition – DSM-5), psychopathy and sociopathy remain as what are referred to as ‘constructs’.  Psychological ‘constructs’ are considered to be hypothetical variables that cannot be observed.

In 2013, a proposal to introduce a diagnosis of ‘psychopathic personality disorder’ into the DSM-5 was rejected and so we remain almost stuck with knowledge of our ‘paths’ but only one way to diagnose them. 

I’ll cover this issue in the next newsletter. Watch out for this in the near future.
Ciara