APD / Sociopathy Prevalence

Factual Questions
1

So I’m reading a book about sociopaths - how they’re really out there in society, and how to defend oneself against them. The book claims that incidence of sociopathy is 4% - about 1 in 25, but the author doesn’t say where she got that number. She also spends a whole lot of the book explaining how determining sociopathy takes many years.

Wikipedia says sociopathy is an obsolete term for Antisocial Personality Disorder, and occurs in about 3% of males and 1% of females. Its cite is a page that says the same thing with no attribution. Most internet pages are just chasing each other with the statistic, without any of them saying what their number is really, ultimately based on.

What is the incidence of people with no morals, no conscience? Is it really a binary thing? Intuition tells me it would be a scale - some people have no remorse, some just a little, some a lot. Everybody talks likes it’s binary, though.

2

In the DSM, there are I believe 7 criteria that are hallmarks of antisocial personalities. The patient has to show at least three of them to be diagnosed, and these individuals would be part of the 3%/1% group. Someone with fewer may have traits of the disorder but no formal diagnosis, these individuals will tend to be politicians and executives :wink: (but some APD traits can be beneficial in small doses, really).

I heard the 3%/1% thing too in many sources, but can’t turn up a definitive cite. I also see that they are a large percentage of people in jail. One definition for psychopath is that they additionally show callous disregard for others; so not all APD fit this criterion. Don’t know how current that is.

3

This study on oxytocin found that 2% of people are not responsive to it, however I don’t know if it is definitive that that 2% is made up wholly or mostly of sociopaths.

I’ve also heard the concept that it is linear like depression or autism rather than just binary. Some people are partial sociopaths in certain environments (pretty much everyone is capable of showing sociopathic tendencies in some situations), progressing to full on sociopaths who are incapable of emotions like empathy or fear.

4

Is empathy an emotion? Not to nitpick, but I thought it was more of a process. The ability to feel an echo of other people’s emotions.

5

What the author of The Sociopath next Door calls “sociopathy” is more commonly called “psychopathy” in scientific literature. Psychopathy is a marked by a constellation of personality features such as callousness, grandiosity, manipulativeness, lack of remorse, superficial charm, pathological lying, criminal versatility, and so on, that indicate a near total or profound lack of conscience as you or I understand it. In its purest form, psychopathy is not simply a deficit of conscience and not merely a matter of not feeling as remorseful as society dictates that one shoud feel when one wrongs another person, but rather a complete lack of empathy with other people on even the most basic level. If you explain to a prototypical psychopath why he should feel “bad” about the things he has done another person, rather than reflect on what you have said and possibly empathize with that person, the psychopath will attempt to read you for the socially appropriate reactions and imitate the social cues of normal human behavior he has learned from you and other people. On a certain level, he lacks a conscience to such a degree that he has to study other people in order to act how people act when they feel “guilt.” A psychopath is very, very different from you.

Antisocial Personality Disorder isn’t exactly the same thing as psychopathy (and sociopathy is a problematic term because it’s often used as a synonym for both). Antisocial Personality Disorder was supposed to replace the terms “psychopathy” and “sociopathy,” but that hasn’t worked out as intended. When Antisocial Personality Disorder was first included in the DSM it was supposed to be a new diagnostic term for what was then being called both sociopathy and psychopathy. The DSM even went as far as to declare those terms obsolete, but it didn’t work out that way - the research on psychopathy has advanced to the point to where it’s safe to say that the DSM criteria for Antisocial Personality Disorder don’t adequately describe psychopathy. Much of the problem is that the criteria for Antisocial Personality Disorder describe criminal behavior, while the current psychological model for psychopathy describes the person’s interior mental state and lack of conscience, not just the external things they do and behaviors they exhibit. Most psychopaths will meet the criteria for Antisocial Personality Disorder, but most peope who meet the criteria for Antisocial Personality Disorder aren’t psychopaths - most are garden variety criminals. Somebody with Antisocial Personality Disorder may have a deficit of conscience but completely and fundamentally lack a conscience as would a true, prototypical psychopath.

So, the long and short of it is that in prison roughly 20% will qualify as true, prototypical psychopaths (psychopaths tend to bioaccumulate in prison), but 80% of will meet the DSM criteria for Antisocial Personality Disorder. In the free world, it’s harder to estimate, since we don’t have psychopaths “under glass” for study like we do in prison settings, but estimates for the incidence psychopathy in the general population have been as high as 4% to (rarely) 6%. The most well respected figure in the field, Dr. Robert Hare, estimates the incidence of psychopathy in the general population at 1%.

6

Too late to edit, but in response to your question about a " scale," you’re more or less correct that there’s a “scale” of morality and conscence, which is more or less what the Psychopathy Checklist measures. Somebody who meets criteria for Antisocial Personality Disorder may register high on that scale and have less morality and conscience than most people, while a psychopath may top that scale out and lack any morality or conscience at all.

7

I’d describe empathy as a “sense”, like sight or sound. It’s an emotion-based process, but not necessarily emotional, if you catch my drift.

8

Don’t forget that all the personality disorders are being revamped for the DSM-5. So not only is sociopathy linear, it rarely occurs by itself.

And I would not consider empathy a sense, because it can be taught. The limitation is that the person has to want to learn.

9

My understanding is sociopaths don’t feel empathy or anxiety, so the emotions that come from them are foreign to them. Compassion, mercy, remorse, love, guilt, fear, terror, etc.

Empathy may not be an emotion itself but it is necessary for other emotions like guilt or love to exist.

10

Yes, good point. The DSM V proposal for “Antisocial/Psychopathic Type” allows for overlap with other personality types, takes into account more internal character traits than the current behavior oriented Antisocial Personality Disorder model, and organizes by scale:

5 Very Good Match: patient exemplifies this type
4 Good Match: patient significantly resembles this type
3 Moderate Match: patient has prominent features of this type
2 Slight Match: patient has minor features of this type
1 No Match: description does not apply

Proposed Revisions: Antisocial/Psychopathic Personality Disorder Type

11

That sounds right to me, at least for complex or secondary emotions. When I say secondary, I mean that there must first be another emotion or thought before it arises.

I’m not sure that fear and terror are always missing. I can’t say I’ve done a lot of research on the topic, but those seem like primary reactions. Guilt, on the other hand, requires an awareness that it’s possible to choose one’s actions. I’ve read that small children can’t feel guilt because they react rather than feeling like they’re choosing actions. They can feel shame, but not guilt. I’d be willing to believe that a (flavor of the year)-path wouldn’t feel eather.

Do -paths not feel any anxiety, or just no social anxiety?

12

They can, but may not experience it in the same way as you or I. You could say that they can be anxiety deficient in the same way that they tend to be emotionally shallow; Dr. David Lykken described it as a “low anxiety IQ.” Some studies have shown that psychopaths can have a reduced physiological response to fear or anxiety, like not as much increased palmar sweating or increased heart rate when anticipating an electric shock, or a decreased startle response to stimuli that the average person responds reflexively to. On the other hand, I think it’s fair to say that they can be under stress, and can understand threatening stimuli on at least an intellectual level and find that unpleasant - Ted Bundy’s trial antics grew increasingly explosive as his trial progressed and it became more and more clear that things were not going well for him (photo of Bundy freaking out in court), and when his execution date arrived he reportedly had to be forcibly extracted from his cell.

13

I’ve had a close encounter with a psychopath over the last four years, and as a result have done a geat deal of research trying to understand and predict his behavior. He does not know what it is to feel badly about something he’s done simply because it was wrong, or hurt someone else. (remorse) He can, however, deeply regret an action if it causes him inconvenience or pain. He does not internally feel any negative result from simply realizing that he has done wrong. He does, however, have a pathological fear of getting caught doing wrong, and he experiences anxiety and fear in that regard. He fears punishment.

I think empathy is a basic sense rather than an emotion. There are specific “mirror neurons” ( Mirror neuron - Wikipedia ) which respond to the actions of others autonomically. This is the mechanism, for instance, which causes us to yawn when we see someone else do so. (A great way to spot psychopaths, incidentally, because they don’t.) We can’t choose whether to be touched by another’s suffering any more than we can choose whether to smell something. We may be able to avoid wrinkling up our nose at the smell, or allowing ourselves to dwell on other people’s problems, but we can’t choose simply to not perceive it. The psychopath can not perceive it; and explaining it to him is as difficult as explaining “blue” to a man blind from birth.

So there’s the basic perceptive ability, and then there’s the turn of character. I think that there is an empathy/narcissism spectrum which has the codependent at one end and the sociopath at the other.

The next step toward the Hollywood horror version or the ASPD is, IMHO nurture. It’s important to note that psychopathy is not necessarily co-morbid with enjoyment of cruelty, (sadism) or sexual dysfunction (pedophilia, etc.). These things are the result of ill treatment in childhood. When all these things combine together, we get monsters.

Here’s a fascinating article about a scientist who discovered that he clearly had the brain scan of a psychopath. He also, however, had a loving, gentle upbringing, and is by all reports a caring and gentle man. He is a good man because it’s what he’s been taught, and what he wants to be, but he probably does not receive empathetic information in the way the rest of us do. A Neuroscientist Uncovers A Dark Secret : NPR

So, I said all that so I could say this: the numbers like 1 in 4 are counterintuitive, because they do not necessarily represent the number of serial killers or child abusers in the human population. Rather, they represent the numbers of people who operate without the basic mirror neurons firing. They are only potential serial killers.

Which leads us to the simple solution: We as a society will suffer the horrors to exactly the extent that we allow children to be abused. If we want to clear out the supermax prisons, we need only make a committment to protecting and treating the abused children in our midst.

Good luck getting the politicians to vote for the funds though.