How to treat a sociopath
Antisocial personality disorder - Diagnosis and treatment
People with antisocial personality disorder are unlikely to believe they need help. However, they may seek help from their primary care provider because of other symptoms such as depression, anxiety or angry outbursts or for treatment of substance misuse.
People with antisocial personality disorder may not provide an accurate account of signs and symptoms. A key factor in diagnosis is how the affected person relates to others. With permission, family and friends may be able to provide helpful information.
After a medical evaluation to help rule out other medical conditions, the primary care provider may make a referral to a mental health professional for further evaluation.
Diagnosis of antisocial personality disorder is typically based on:
- A psychological evaluation that explores thoughts, feelings, relationships, behavior patterns and family history
- Personal and medical history
- Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Though typically antisocial personality disorder isn't diagnosed before age 18, some signs and symptoms may occur in childhood or the early teen years. Usually there is evidence of conduct disorder symptoms before age 15.
Identifying antisocial personality disorder early may help improve long-term outcomes.
- Complete blood count (CBC)
Antisocial personality disorder is difficult to treat, but for some people, treatment and close follow-up over the long term may be beneficial. Look for medical and mental health professionals with experience in treating antisocial personality disorder.
Treatment depends on each person's particular situation, their willingness to participate in treatment and the severity of symptoms.
Psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for alcohol or substance misuse, and treatment for other mental health conditions.
But psychotherapy is not always effective, especially if symptoms are severe and the person can't admit that he or she contributes to serious problems.
There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression. Certain drugs are usually prescribed cautiously because they have the potential for misuse.
- Cognitive behavioral therapy
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Coping and support
Skills for family members
People with antisocial personality disorder often act out and make other people miserable — with no feeling of remorse. If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself.
A mental health professional can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. He or she can also recommend strategies for coping.
Seek a mental health professional who has training and experience in managing antisocial personality disorder. Ask your loved one's treatment team for a referral. They may also be able to recommend support groups for families and friends affected by antisocial personality disorder.
Preparing for your appointment
If a medical evaluation rules out physical causes for your behavior, your primary care provider may make a referral to a mental health professional, such as a psychiatrist or psychologist.
Take a family member or friend along to your appointment, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the doctor that you don't think to bring up.
What you can do
Before your appointment, make a list of:
- Any symptoms you or your family noticed, and for how long
- Key personal and medical information, including current physical or mental health conditions, personal or family history of mental illness, traumatic experiences, or major stressors
- All medications you take, including the names and doses of any medications, herbs, vitamins or other supplements
- Questions you want to ask your doctor to make the most of your appointment
Some basic questions to ask your doctor include:
- What is likely causing my symptoms?
- What are other possible causes?
- What treatments are most likely to be effective for me?
- How much can I expect my symptoms to improve with treatment?
- How often will I need treatment, and for how long?
- Are there medications that can help? Is so, what are the possible side effects?
- Is there a generic alternative to the medication you're prescribing?
- Are there any printed materials I can have? What websites do you recommend?
Don't hesitate to ask any other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- What are your symptoms?
- When did you or your family first notice these symptoms?
- How are your symptoms affecting your life?
- Have relatives or friends expressed concern about your behavior?
- Do you have any close relationships?
- If you're not satisfied with work, school or relationships, what do you think is causing your problems?
- Have you ever thought about harming yourself or others? Have you ever actually done so?
- Have any of your blood relatives, such as a parent or sibling, been diagnosed with or treated for mental illness?
Be ready to answer these questions to reserve time to go over points you want to spend more time on.
By Mayo Clinic Staff
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Definition, vs. Psychopath, Test, Traits, and Symptoms
The term sociopath refers to someone living with antisocial personality disorder (ASPD) — as does the term psychopath.
The most recent edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), which mental health professionals use to diagnose mental health conditions, defines ASPD as a consistent disregard for rules and social norms and repeated violation of other people’s rights.
People with the condition might seem charming and charismatic at first, at least on the surface, but they generally find it difficult to understand other people’s feelings. They often:
- break rules or laws
- behave aggressively or impulsively
- feel little guilt for harm they cause others
- use manipulation, deceit, and controlling behavior
Both sociopathy and psychopathy have become well-recognized terms among mental health professionals, but neither represent an official diagnosis. They also carry a lot of stigma, particularly for people living with personality disorders, so it’s best to avoid describing anyone displaying violent or manipulative behavior as “sociopaths” or “psychopaths. ”
Instead, focus on specific behaviors and actions. Rather than labelling a controlling ex as a sociopath, for example, you could say, “He would regularly remind me he was monitoring my social media activity.”
Experts first began using the term sociopathy during the 1930s. Unlike “psychopathy,” it wasn’t easily confused with “psychosis.” The prefix also reflected a widely-held belief that the traits and behaviors associated with sociopathy related to socio-environmental factors.
Many researchers used sociopathy and psychopathy interchangeably until ASPD was added to the third edition of the DSM in 1980.
In a clinical setting, there’s no actual difference between sociopathy and psychopathy. A mental health professional won’t diagnose either of the two.
Some psychologists and researchers do make key distinctions between sociopathy and psychopathy. But these terms simply offer two slightly different ways of understanding the diagnosis of ASPD
In these interpretations, psychopathy is sometimes seen as involving more planned behavior. The behavior might not necessarily be violent, but it’s typically premeditated.
Research supports a few of these distinctions — to an extent.
Robert Hare, the psychologist who created the Psychopathy Checklist (PCL-R), defined sociopathy as involving a conscience and sense of right and wrong, or morality. But that sense of morality doesn’t line up with cultural and social norms. Instead, people with sociopathy often justify actions they recognize as “wrong.”
In a nutshell, people with sociopathy may have little empathy and a habit of rationalizing their actions. But they do know the difference between right and wrong.
Psychopathy, according to Hare, involves no sense of morality or empathy.
Research from 2013 suggests the difference between psychopathy and sociopathy may relate to differences in the brain, including gray matter volume and amygdala development. For people with sociopathy, increased neuron function in certain parts of the brain may factor into the development of some sense of morality.
There’s no standard list of sociopath signs, but the signs and symptoms of ASPD include a persistent pattern of disregard for others. For example:
- ignoring social norms and laws, or breaking rules at school or work, overstepping social boundaries, stealing, stalking and harassing others, and destroying property
- dishonesty and deceit, including using false identities and manipulating others for personal gain
- difficulty controlling impulses and planning for the future, or acting without considering the consequences
- aggressive or aggravated behavior, including frequent fights or physical conflict with others
- disregard for personal safety, or the safety of others
- difficulty managing responsibilities, including showing up at work, handling tasks, or paying rent and bills
- little to no guilt or remorse, or a tendency to justify actions that negatively affect others
People with ASPD generally show little emotion or interest in the lives of others. They might:
- come across as arrogant or superior, with firmly fixed opinions
- use humor, intelligence, and charisma to manipulate
- seem charming at first, until their self-interest becomes clear
People with ASPD generally find it challenging to maintain friendships, relationships, and other mutually fulfilling connections. This difficulty may stem from traits, like:
- low empathy and emotional intelligence
- difficulty learning from mistakes
- lack of concern for the safety of others
- a tendency to intimidate and threaten in order to maintain control
Many experts consider sociopathy more of an environmental construct than a genetic one.
Yes, brain chemistry and inherited genes play a part, but parenting styles and upbringing, along with other environmental factors, carry the most weight. (Psychopathy, on the other hand, appears linked to more innate biological factors.)
Children who don’t receive nurturing attention from caregivers tend to grow up learning they have to take care of themselves, because no one else will. Some children who experience abuse, violence, and manipulation from an early age may come to model this behavior as they navigate their own conflicts.
Research also suggests it’s possible to “acquire” sociopathy. Trauma or damage to the frontal lobes of the brain, which can happen as a result of a head injury or progressive conditions, like dementia, can lead to some antisocial behaviors.
Again, keep in mind that the DSM-5 makes no distinction between sociopathy and psychopathy, or any separate subtypes of ASPD.
Mental health professionals use DSM-established criteria to diagnose ASPD. This diagnosis can apply to someone whose behavior aligns with the accepted definition of either sociopathy or psychopathy.
A diagnosis of ASPD requires at least three of the seven signs listed above, plus a few additional criteria:
- These behaviors appear across multiple areas of life.
- The person is at least 18 years old.
- They had some symptoms of conduct disorder before the age of 15. This helps distinguish ASPD from lawbreaking behavior that begins in adulthood.
- Antisocial traits and behaviors don’t relate to schizophrenia or bipolar disorder.
To make a diagnosis, a therapist or psychologist might:
- ask questions about a person’s feelings, thoughts, behavior, and personal relationships
- ask (with permission) family members and romantic partners about their behaviors
- evaluate their medical history for signs of other conditions
Keep in mind that personality disorders, including APSD, involve traits that are beyond the person’s control. These characteristics go beyond a desire for personal gain and tend to remain fixed over time, causing distress.
Could it be a different condition?
Other mental health conditions can involve symptoms similar to ASPD:
- Intermittent explosive disorder (IED) involves extreme and repeated verbal or physical outbursts. These outbursts, driven by impulse or anger, can be directed toward people, property, or animals. IED commonly begins in adolescence and usually before the age of 40. On its own, it doesn’t involve low empathy or lack of remorse.
- Conduct disorder involves antisocial behavior that typically begins by the age of 16. Experts consider this condition a major risk factor for ASPD. Adults must show signs of conduct disorder in childhood to be diagnosed with ASPD. Someone who doesn’t meet full ASPD criteria might be diagnosed with conduct disorder.
- Schizophrenia often involves trouble recognizing facial emotions, a trait also associated with ASPD. The condition may involve aggressive or antisocial behavior — but not always. It also involves psychosis, while ASPD does not. Experts won’t diagnose ASPD before treating schizophrenia.
- Bipolar I disorder. Episodes of mania can involve impulsivity, aggression and irritability, and increased thoughts of suicide — symptoms also linked to ASPD. Experts won’t diagnose ASPD during an episode of mania.
People living with personality disorders don’t always recognize any issues with their behavior, so they often don’t consider getting professional support.
They might choose to work with a therapist if prompted by a court order or someone in their personal or professional life.
Work supervisors, family members, and romantic partners might notice traits, like impulsivity and a tendency toward aggressive outbursts, for example, and they may recommend professional support.
Some people also try therapy to address other challenges or mental health concerns, including:
- difficulty coping with boredom or stress
- substance use disorders
But since many people living with ASPD never choose to go to therapy, little research on helpful treatment approaches exists. That doesn’t mean treatment can’t help. But therapy and other approaches generally only work when someone willingly puts in the effort.
Possible treatments for ASPD include the following.
Therapy involves talking to a therapist about thoughts and feelings that can prompt harmful or aggressive behavior. It might also include anger management tactics or treatment for substance use.
Potentially beneficial approaches include:
- Cognitive behavioral therapy (CBT). CBT can help people learn to consider their responses to people and situations, which may lead to more productive behaviors. Therapy can, for example, help someone recognize the benefits of using negotiation rather than violence to solve conflict or disagreements. CBT also involves psychoeducation, which can teach people more about ASPD.
- Mentalization-based therapy (MBT). This approach aims to help people learn to better identify and understand mental and emotional mindsets — both their own and those of others. A small 2016 study suggests MBT helped reduce hostility and anger, paranoia, self-harm and interpersonal difficulties in people living with both ASPD and borderline personality disorder, along with leading to an improved mood overall.
- Democratic therapeutic communities. This approach, often used in prisons, involves therapy groups of various sizes that help participants make collaborative decisions as part of a group and work together on problems affecting the community. It can help boost community-minded and prosocial thinking in people living with ASPD.
- Contingency management. This approach offers rewards to encourage treatment progress. Older research suggests it can help people living with ASPD limit intake of alcohol and other substances.
The Food and Drug Administration (FDA) hasn’t approved any medications to treat symptoms of ASPD.
A doctor or psychiatrist may recommend medication for symptoms associated with the condition, such as:
- antipsychotics, like risperidone (Risperdal), as a first-line treatment for aggression
- SSRI antidepressants, like fluoxetine (Prozac), or mood stabilizers, like lithium, to help treat aggression
- anticonvulsants, like carbamazepine (Tegretol), to help reduce impulsivity
According to a small 2014 study, the antipsychotic medication clozapine (Clozaril) shows some promise as a treatment for men with ASPD. After taking the medication for several weeks, all seven participants experienced improvement in ASPD symptoms, including anger, impulsivity, and violence or aggression.
If you’d like to work on maintaining your relationship with someone who has ASPD, it may help to:
- recognize they may never fully understand your emotions
- explain specific ways their behavior affects others
- establish clear boundaries to protect your emotional and physical space
- encourage them to get professional support
Marriage or family counseling can also help you develop a more positive relationship with a loved one living with ASPD.
Ultimately, they may choose not to respect your boundaries and continue to cause emotional distress or physical harm. In that case, ending the relationship, or at least creating space from it, may be your safest option.
Working with a therapist yourself can also help you:
- explore productive communication
- build coping skills
- identify signs of abuse
- work on a plan to safely leave a relationship if needed
A therapist can also offer more specific guidance on handling problematic behaviors, including manipulation and control tactics or outbursts of anger.
Personality researchers and experts continue to explore the nuances of sociopathy and psychopathy. Still, they have yet to establish unique criteria to diagnose either, and ASPD remains the closest diagnosis to what people typically think of as psychopathy.
There’s no cure for ASPD. Some research suggests, though, that antisocial behavior often decreases over time. By middle age, people are less likely to behave in violent or aggressive ways.
Therapy approaches that help people learn to replace problematic behaviors with more constructive ones can also make a difference for ASPD symptoms.
In short, it’s absolutely possible for people with ASPD to build stable and fulfilling relationships with others, though it does take work.
Contrary to media portrayals, people who show signs of sociopathy don’t choose to be “evil.”
In many cases, they’re likely living with ASPD, a condition that develops from a combination of genetic and environmental factors, including childhood abuse and neglect.
Main symptoms and treatment of sociopathyMain symptoms and treatment of sociopathy
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A sociopath is an asocial person who has a clinical inability to adapt in society. The main symptoms and treatment of sociopathy are still being researched by scientists, as sociopaths pose a real threat to society due to their deviant behavior. Despite the colossal research of scientists, the causes of sociopathy have not yet been reliably determined. At the moment, there are two polar points of view on the etiology and pathogenesis of this dangerous disorder.
According to the first point of view of scientists, sociopathy is inherited or is the result of gene mutation. Another point of view is related to the beliefs of many experts that sociopaths are brought up by society. That is, the causes of the disease should be sought in the social environment and upbringing. This opinion can be partially refuted, since children brought up in a favorable social environment can become sociopaths. But it cannot be denied that society can indirectly influence the aggravation of sociopathy and its transition from a passive to an active form. The researchers also note that the symptoms of sociopathy may appear in people with schizophrenia or mental retardation.
Characteristic manifestations of sociopathy can be punishable and formally non-punishable actions. The first includes robberies, murders and violence. The second group includes less criminal actions, which are nevertheless condemned by society: purposeful avoidance of work duties, inappropriate behavior on the road, and other actions. even demonstratively violates them. At the same time, no matter how terrible and pathological his actions would be, he does not feel guilty for them, because he is not able to critically evaluate his behavior. Also, experts identify such signs of sociopathy as disregard for human life, the ability to manipulate people to achieve their goals, the appearance of strong aggression and rage in case something violates the sociopath's internal well-being.
The treatment of sociopathy is extremely difficult, because often a sociopath does not decide to come to a psychotherapist on his own, and if he agrees to an appointment, he manipulates the doctor rather than listens to his advice. Unfortunately, today there is no really effective technique that would help get rid of this mental disorder for all sociopaths without exception. Group or family therapy can have a more or less effective effect on a sociopath. The main task of the psychotherapist is to make the patient think about the needs and feelings of other people, as well as to teach him to be more condescending and patient towards loved ones.
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Dissocial personality disorder, sociopathy is a mental deviation, which is characterized by ignoring generally accepted social norms, high aggression, and the impossibility of building normal relationships with others. The signs of sociopathy are quite pronounced, but it is difficult to diagnose this deviation even for an experienced doctor. That is why the treatment of sociopathy should be carried out in a clinical setting - the line between sociopathy and psychopathy, schizophrenia, and neurosis is too thin.
Causes and signs of sociopathy
Until now, the reasons for the development of antisocial personality disorder have not been fully elucidated, but doctors are inclined to believe that the following factors play a large role in the formation of such a personality:
imitating the behavior of a sociopath who is in the immediate environment;
incorrect upbringing of the child;
dysfunctional family (drinking parents, despotic father).
Working with patients as part of the sociopathy treatment program, experts note that they become those who were specially instilled in childhood that aggression, distrust, indifference to others is the norm, because society is cruel and does not give the right to be gentle, understanding, to show sympathy and pity. Usually there is a "layering" of provoking factors; it is impossible to single out any one specific cause of a personality disorder.
The first symptoms of the condition in question are clearly visible even in childhood and adolescence, there are no periods of remission, and the disorder only becomes more intense. The main symptom of the condition under consideration is inadequate behavior, which can be directed both at others (physical violence, moral humiliation) and at oneself: a person begins to take drugs, alcohol, and lead a promiscuous sex life. In addition, the obvious signs of sociopathy include:
inability to make plans for a long time;
lack of ability to calmly endure infringements of their rights;
the use of physical force in case of non-fulfillment of desires;
inability to take into account the feelings, desires of other people;
prone to manipulation.
Sociopaths first make a very good impression, and only under certain conditions, others consider them aggression, irritability, and a lack of guilt. People with antisocial disorder can adequately respond to the rules of society, comply with conventions only if there is a personal benefit.
Clinical treatment of sociopathy
Before the psychiatrist and other specialists begin to select treatment regimens for sociopathy, they conduct a diagnosis. To confirm the diagnosis, doctors must clearly identify at least 3 symptoms from the following:
the rapid emergence of aggression "out of the blue", which turns into a physical form of manifestation;
the inability to draw their own, logical conclusions from the situation;
complete absence of guilt for committed actions;
lack of emotional manifestations to people;
there is no desire to comply with social norms and maintain contacts in society;
making unfounded claims;
comfortable being in conflict between other people.
In childhood and adolescence, diagnosis is difficult because sociopathy is manifested by excessive impulsivity, periodic aggressiveness, and rejection of the established norms of society.
Even modern methods of treating sociopathy do not lead to a full recovery, it is only possible to achieve a correction of the behavior of a person with a dissocial disorder. In our clinic in Moscow, the program for the treatment of sociopathy includes:
Psychotherapy. As a result of classes with a psychotherapist, the patient learns to manage his own emotions, restrain negativity, ignore the desire to use physical force, and manages to refuse the use of prohibited substances or alcohol.
Medical therapy. It is selected on a strictly individual basis, drugs are taken by patients in the event that the treatment of sociopathy takes place in a hospital - you need to monitor the condition and the exact dosage. Antipsychotics and antidepressants are often prescribed. Doctors prefer to carry out drug therapy only if the patient leaves the framework of strict control.
Family psychotherapy. If there is a sociopath in the family, then all close people suffer from his behavior. The patient commits acts that hurt relatives, but do not feel guilty. Our specialists will teach the relatives of a sociopath to set limits that will help to avoid aggressive attacks, physical assault and violence.
There is no single treatment regimen for sociopathy; qualified assistance can only be provided by professionals in a clinical setting. You should not rely on luck and try to reason with a sociopath on your own - such people have no sense of guilt at all, they cannot understand the emotions of their loved ones and those around them. Call our mental health center to make an appointment and get an initial consultation regarding treatment options for sociopathy.
Answers to questions
In our clinic, psychotherapists help sociopaths.