Is psychopathy a diagnosis

What’s the Difference Between a Psychopath and a Sociopath?

Written by Keri Wiginton

In this Article

  • What Is Antisocial Personality Disorder?
  • What Is Psychopathy?
  • Do Either Have a Conscience?
  • Are They Violent?
  • Hot-Headed vs. Cold-Hearted
  • What Causes It?
  • Can They Get Better?

You’ve probably heard of a “sociopath” or “psychopath.” These words refer to people who don’t care about right or wrong or can’t sense or share other people’s feelings. Maybe they describe a person who’s also charming or violent -- or both.

People often use these terms to mean the same thing. While experts agree so-called sociopaths and psychopaths share some similar traits, there are some important differences.

What Is Antisocial Personality Disorder?

Doctors don’t diagnose people as sociopaths or psychopaths. They use the term antisocial personality disorder. They used to call it sociopathy. A person who had this diagnosis was a sociopath. But doctors don’t use these labels anymore. There’s some debate over whether psychopaths have a serious form of this personality disorder or a separate but related diagnosis.

People with antisocial personality disorder act in ways that go against socially acceptable norms. They tend to break laws and feel little or no guilt when they do something wrong. This condition usually develops in childhood, but you can’t get a diagnosis until you’re 18 or older. (Doctors diagnose kids who have antisocial problems with conduct disorder.)

People with this personality disorder might do things such as:

  • Deceive others for personal gain.
  • Commit crimes.
  • Disregard rules or the safety of others.
  • Act impulsively or aggressively.
  • Act coldly toward others.
  • Lie about big and little things.
  • Have few, if any, close relationships.
  • Have trouble keeping a job or doing schoolwork.
  • Take unneeded risks.

What Is Psychopathy?

Psychopaths are people who demonstrate psychopathy. That’s not a diagnosis but a set of traits. The criteria for psychopathy include psychological symptoms and certain specific behaviors. The measures of antisocial personality disorder, on the other hand, focus mostly on behaviors you can see.

Around 25%-30% of people with antisocial personality disorder also have psychopathy. But you can’t know if someone has psychopathy just by testing them for antisocial disorder. Instead, a trained clinician will commonly use something called the Hare Psychopathy Checklist-Revised. That’s a list of 20 characteristics. The clinician will consider someone, usually a criminal, a psychopath if they “score” high on the checklist.

Here are some of the traits common to psychopaths:

  • Insincere charm
  • Easily bored
  • Compulsive lying
  • Manipulative
  • No remorse or guilt
  • Little emotional reaction
  • Cruel with no empathy
  • Take advantage of others
  • Behavior problems start in childhood
  • Don’t accept responsibility
  • Many sexual relationships

Studies focus mostly on male psychopaths. They make up about 1% of the general population, but they comprise 20%-30% of those in U.S. prisons. Research shows that psychopaths are 15 to 25 times more likely to break the law and end up in prison than others.

Do Either Have a Conscience?

People with antisocial personality disorder -- that is, sociopaths -- likely know what they’re doing is wrong. But their moral compass is weak. They have a conscience; it’s just not strong enough to stop their bad behavior.

But experts don’t think people with psychopathy have a conscience.

Are They Violent?

Anyone can hurt another person. That includes people with antisocial personality disorder. But they aren’t always violent. Psychopathy, on the other hand, is a strong predictor of aggression and violence over someone’s lifetime.

Here’s what some research shows:

  • About 90% of people released from prison who scored high in psychopathy committed a violent crime within the next 20 years. Only 40% of those who scored low in psychopathy did the same.
  • Psychopaths are responsible for the deaths of more than 50% of police officers who die in the line of duty.

Hot-Headed vs. Cold-Hearted

People with antisocial personality disorder who aren’t psychopathic are more likely to be impulsively aggressive. That means they are hot-headed or don’t have much control over their behavior when they get angry. They’re also not very good at planning for the future.

But psychopaths are more cold-hearted than hot-headed. Studies show they have low levels of anxiety, and they don’t react all that much to stress or punishment. Plus, they have good control over their thoughts and tend to plan out their aggressive acts.

What Causes It?

It’s unclear why some people get antisocial personality disorder or psychopathy. It’s likely that a bunch of different things play a part, such as:

  • The brain. Studies show that there may be a problem with the brain circuitry that controls behavior in people with this condition. Research also shows that certain parts of the brains of people with psychopathy are smaller. That includes the areas that control empathy, moral decision-making, guilt, and embarrassment.
  • Genetics. You’re more likely to get this disorder if someone in your family, such as a parent, has it.
  • Sex. Antisocial personality disorder and psychopathy can happen in females, but they are much more likely to show up in males.
  • Environment. There’s some evidence that people with this disorder don’t learn the difference between right and wrong as they’re growing up.


Can They Get Better?

Antisocial personality disorder is hard to treat. That’s partly because so-called sociopaths or psychopaths aren’t the kind of people who think they need help. But certain symptoms may show up in childhood. When that happens, if parents take action and get help for their child, they may get better.

There isn’t enough evidence to know if any kind of treatment will actually work. But if someone with this condition does get help, their doctor may try talk therapy to address anger issues or other mental health problems. Medication may help with behavior problems like aggression or depression, but drugs can’t cure antisocial personality disorder or psychopathy.

If you’re around someone who you think has this condition, look out for yourself. Find a support group or reach out to a mental health professional. Ask your doctor for a referral to someone who has experience treating people with personality disorders.

Meaning, Signs, and vs. Sociopath

Psychopathy, while not a clinical diagnosis, often refers to someone with antisocial personality disorder.

Few psychology terms stir up confusion like “psychopath.” Even though it’s commonly (though incorrectly) used to describe someone who has a mental health condition, “psychopath” is not an official diagnosis. Instead, it’s an informal term often used for a condition called antisocial personality disorder (ASPD).

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not list psychopathy as an official clinical diagnosis.

The true definition of a psychopath in psychiatry refers to someone with ASPD, explains Dr. Prakash Masand, a psychiatrist and co-founder of the Centers of Psychiatric Excellence. ASPD describes a condition marked by patterns of manipulation tactics and violation of others.


Masand says one thing that can be confusing about ASPD is the phrase “antisocial.”

“Most people might assume this describes someone who is reserved, a loner, keeps to himself, etc. However, this is not the case in ASPD,” he explains. “When we say antisocial in ASPD, it means someone who goes against society, rules, and other behaviors that are more commonplace.”

While some clinicians regard psychopathy as a more severe subtype of ASPD, the general consensus is that psychopathy falls under the umbrella of ASPD. In this article, we refer to information about ASPD.

Read on to learn more important information about ASPD, such as the signs, diagnostic criteria, and treatment options.

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Since the term “psychopath” is not an official diagnosis, experts refer to the signs described under ASPD. According to Masand, some of the more common signs of ASPD can include:

  • behavior that conflicts with social norms
  • disregarding or violating the rights of others
  • inability to distinguish between right and wrong
  • difficulty with showing remorse or empathy
  • tendency to lie often
  • manipulating and hurting others
  • recurring problems with the law
  • general disregard toward safety and responsibility
  • expressing anger and arrogance on a regular basis

Other possible signs of ASPD include a tendency to engage in behavior that’s reckless, impulsive, or may lead to harmful consequences.

Masand says someone exhibiting this behavior may also:

  • lack deep emotional connections
  • have a superficial charm about them
  • be very aggressive
  • get very angry sometimes

Additionally, people with ASPD may not react as if they have hurt someone, and they may be impulsive or abusive and may lack remorse. In the case of ASPD, abusive doesn’t necessarily mean violent.

In addition to the signs and behaviors, Masand says there are certain characteristics that are more prevalent in people with ASPD:

  • ASPD is more common in men than women.
  • Technically, to receive an ASPD diagnosis, you have to be at least 18 years old. But some children will show signs of conduct disorder, which may be an early indicator of ASPD.
  • ASPD is a chronic (long-term) condition that seems to improve with age, and remittance (no longer showing signs of antisocial behavior) is possible.
  • Mortality rates are higher in people with ASPD because of their behavior patterns.

Since psychopathy is not an official mental health condition, the condition experts diagnose is ASPD. This is one of four cluster B personality disorders outlined by the DSM-5, and the other three are:

  • borderline personality disorder (BPD)
  • histrionic personality disorder (HPD)
  • narcissistic personality disorder (NPD)

Before explaining the criteria used to diagnose ASPD, it’s important to mention that diagnosing and treating ASPD presents some unique challenges.

According to Masand, ASPD can be difficult to treat because the person who needs help often doesn’t believe there is a problem with their behavior. As a result, they rarely seek treatment.

That said, according to the established guidelines used to diagnose ASPD, the behavior generally begins by age 15 or in the teenage years. However, Masand says a true ASPD diagnosis is not made until the age of 18.

“For most people, the worst of the behavior occurs in the late teen years throughout the twenties,” he explains.

Diagnostic criteria

To get a proper diagnosis, a mental health professional will conduct a full mental health evaluation. During this process, the mental health professional will evaluate a person’s:

  • thoughts
  • feelings
  • behavior patterns
  • relationships

The mental health professional will identify symptoms and compare them with the ASPD criteria in the DSM-5.

In order to receive a diagnosis of ASPD, a person must show a pattern of disregard for and violation of the rights of others. This is indicated by three or more of the following criteria, according to the DSM-5:

  • failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest
  • deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit
  • impulsivity or failure to plan
  • irritability and aggressiveness, often with physical fights or assaults
  • reckless disregard for the safety of self or others
  • consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations
  • lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person

The mental health professional will also look at a person’s medical history. This full evaluation is a critical step since people with ASPD often have other mental health and substance use disorders.


Because a true ASPD diagnosis is typically delayed until the age of 18, adolescents and teens who display similar symptoms are often evaluated for conduct disorder (CD) or oppositional defiant disorder (ODD).

Of the two behavior disorders, CD is more severe than ODD.

When determining if a child has ODD, mental health professionals will look at how they act around people they know. Typically, someone with ODD is more likely to act oppositional or defiant around family members, teachers, or a healthcare professional.

If an adolescent or teen shows an ongoing pattern of aggression toward others and regularly makes choices in opposition to the rules and social norms at home, at school, or with peers, a clinician may decide to evaluate for CD.

To receive a diagnosis of ASPD before the age of 18, a teen must also have a previous diagnosis of CD by age 15.

“Psychopath” and “sociopath” are often used interchangeably to informally describe someone with ASPD. Since sociopath is also not an official diagnosis, it typically joins psychopath under the umbrella diagnosis of ASPD. There is no clinical difference between the two terms.

Both psychopathy and sociopathy are other terms or ways to describe ASPD. The behaviors that are often seen in both tend to fall under the criteria of ASPD.

While the exact cause of ASPD is not known, researchers believe that its development may involve a combination of environmental and genetic factors.

More research needs to be done to understand the genetic aspects of ASPD. Previous research estimates that between 38 and 69 percent of cases may be hereditary.

Additionally, some of the environmental triggers of ASPD may include childhood neglect and other adverse experiences, such as childhood abuse.

ASPD may also be seen in people who previously received a diagnosis of CD or attention deficit hyperactivity disorder (ADHD).

Like the diagnostic process, treating someone with traits that fall under the ASPD diagnosis can be difficult. Typically, a doctor may recommend a combination of psychotherapy (talk therapy) and medication.

While no evidence supports that any medication or form of psychotherapy can cure ASPD, these methods may still help manage some of the symptoms, like impulsivity and aggression, and improve quality of life.

According to a 2015 review, early interventions in adolescents and teens who received a diagnosis of CD may also help prevent ASPD.

The researchers in the 2015 review also found that for some people with ASPD, the condition may improve or remit as they get older — with improvement occurring at a median age of 35. They also found that people with stronger social ties and support, such as a spouse or family, were more likely to experience remission.

Psychotherapy may be helpful in understanding how the disorder can impact your life and relationships. A mental health professional will work to develop strategies that help decrease the severity of the symptoms.

If medication is part of the treatment plan, a doctor might prescribe medications that treat related mental health conditions, such as anxiety, depression, or symptoms of aggression.

Options may include:

  • antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or bupropion
  • antipsychotics
  • anticonvulsants

The word “psychopath” is often informally used to describe someone with ASPD.

ASPD is notthe same as being “antisocial.” It primarily involves behavior that conflicts with social norms, as well as a general lack of disregard for others.

Despite the complexities surrounding ASPD, a mental health professional may be able to identify this condition and offer treatment that can help.

Read this article in Spanish.

Is psychopathy a disease or a manifestation of character?

Sometimes even in a close environment there may be a person suffering from various mental illnesses. Not always this problem can be detected by an unknowing person. Psychiatrists, on the other hand, make a definite diagnosis only when an individual openly shows aggression and can harm himself or others. In this article, you will learn who psychopaths are, how a disorder called psychopathy manifests itself, and how to avoid mental problems.


  • 1 The concept of psychopathy
  • 2 Unbalance in psychology
  • 3 Psychopathy as a character trait or disease
  • 4 How to recognize a psychopath?
  • 5 Treatment of psychopathy

The concept of psychopathy

A personality disorder that manifests itself in aggressive behavior is called psychopathy. Psychopaths are characterized by heartless, evil behavior, as well as the inability to empathize with others. In most cases, it is difficult for such people to build long-term relationships, so they can be called loners.

Unbalance in psychology

In psychology, this phenomenon is considered as inadequate and aggressive behavior, as well as an evil manifestation of emotions. People with this syndrome do not adhere to the norms of behavior accepted in society. Psychopathy can be congenital, but more often it manifests itself in adolescence, when a hormonal surge occurs. Most clearly, this disorder can manifest itself in a state of alcoholic or drug intoxication.

Psychopathy as a character trait or disease

In science, there are 4 types of human temperament, each of which has upper and lower limits. Despite the advantages and disadvantages of each of the temperaments, a person must adequately perceive himself and the situation. However, there are quite a large number of people in the world who are not able to adequately evaluate actions. If a person loses control of his behavior and begins to show aggression in a situation that he does not understand, then this may be a signal that he has clinical features.

The category of psychopaths can also exhibit antisocial behavior, but this is usually associated with exaggerated character traits. That is why psychopathy is more classified not as a disease, but as a negative character trait.

How to recognize a psychopath?

It is quite difficult to identify an unstable character and psychopathy at the initial stage. Usually such people skillfully hide their true face, hiding behind flattery, and also lie a lot and never admit that they suffer from a mental disorder. Individuals with psychopathy are very fond of extreme sports and do not feel pity for others and animals. They can begin to unload emotionally in various tense situations. For some, sports may be a form of unloading, while others may begin to harm others. Psychopaths are equally common among both women and men.

Treatment of psychopathy

Despite the well-studied characteristics of the disease, there is currently no way to completely get rid of psychopathy. However, with the help of psychological methods, it is possible to maintain a normal state of a person. Psychotherapy with explanations and hypnosis are most often used to correct psychopathy. If the case is too advanced, then hospitalization and treatment of the disease with medication may be required.

In fact, psychopaths can be very close, without showing themselves. Some of them prefer not to consult a psychologist, but try to correct their behavior on their own. A psychopath may not always be a criminal, and a criminal does not always have a mental disorder. And in order for the psyche to be normal, it is necessary to get rid of negative thoughts and emotions in time, for example, with the help of the Wikium course “Brain Detoxification”.

Who are psychopaths and why their image in culture is far from reality


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The psychopathic hero at some point became a popular movie cliché. But due to the interest of popular culture, the meaning of this term has blurred, and the image of a psychopath from films and TV shows has little to do with reality

Who are psychopaths

In April 1999, Eric Harris and Dylan Klebold attacked Columbine High School. They killed 13 people and injured 23. The incident launched a massive discussion about the tightening of gun control and the importance of monitoring the psychological state of teenagers. Both perpetrators of the tragedy were psychopaths, which none of their friends, classmates and teachers noticed.

So who are psychopaths? In science, this is the name for those who suffer from antisocial personality disorder (ADD). Prakash Masand, an American psychiatrist at the Duke-NUS Medical School in Singapore, points out: “Most people assume that psychopaths are reserved, withdrawn, unsociable, etc. However, this does not apply to ARL. When we say that a person suffering from it is anti-social, this means that he goes against society and its rules.

How to spot a psychopath

It's worth noting that "psychopath" is not an official medical diagnosis. Scientists prefer to say "a person with APD". Signs that a person has antisocial personality disorder include:

  • violating or disregarding the rights of others;
  • narcissism;
  • inability to distinguish generally accepted "good" from "bad";
  • lack of responsibility and guilt for misconduct;
  • behavior that does not fit into the standard social framework;
  • constant problems with the law;
  • neglect of one's own safety;
  • difficulty showing sympathy or empathy.

Psychopaths and sociopaths

In the 2010s cult BBC series Sherlock, the protagonist likes to describe himself like this: "I'm not a psychopath, I'm a highly active sociopath." In fact, these two terms mean about the same thing: they are both included in the ARL. Dr. Masanda adds: “Some people like to make an artificial distinction based on the degree of personality disorder, but this is wrong. They will say that psychopathy is a more serious form of sociopathy, but that is also incorrect." However, Michael Tompkins, a psychologist at the California Mental Health Center in Sacramento, is convinced that the difference lies in the presence of a conscience. Psychopaths don't have it at all, while sociopaths may feel guilty for their wrongdoings, but it still doesn't stop them.

Why the portrayal of psychopaths in movies and TV shows is far from reality

Yale University researcher Ariel Baskin-Sommers writes that TV and movies simplify portrayals of psychopaths and form common characteristics that only a fraction of people with APD actually have.

Learn more