Psychopaths, sociopaths and anti-personality disorder

I’ve just read Gfactor’s staff report on psychopaths etc. While it’s fine for what it says, it doesn’t really answer the question fully and, in the end, can be quite misleading in what it doesn’t say.

The bottom line is that a psychopath is the same thing as a sociopath, in that the APA’s DSM (the official source of these definitions) just changed the name of what they considered the same condition. Later on the changed the name again, to Antisocial personality disorder, and modified some of the indicators to try to make them more objective (to focus on displayed and measurable behaviors versus theoretical constructs).

While officially all three terms are supposed to be the exact same thing, some people continued to use old terms instead of changing to the new terms. And because each new term sounded a bit less harsh (trying to be clinical and all), some people used each term to mean different things that were progressively worse the older the term you used was. The most notable of these is Dr. Hare, who felt that the new diagnostic criteria for Antisocial Personality Disorder was too general and would include people who got into criminal trouble in ways that weren’t what he considered “psychopathic” reasons by the old definition. So he, as an expert on the topic who thought he could do better than the APA, started selling his own diagnostic criteria for determining who was a psychopath. He’s gotten a lot of support, especially from law enforcement and corrections personnel who aren’t as likely to care about what the APA says.

So the answer there depends upon which source you consider more credible, the APA or Dr. Hare… or simply noting that there are some disagreements among the experts. As far as the APA is concerned, the materials they sell say there are no psychopaths, just people who used to be called that but who suffer from Antisocial Personality Disorder. Dr. Hare, on the other hand, will gladly sell you materials saying otherwise.

And it would’ve been helpful to further clarify the difference between psychopathic and psychotic, as many people use the terms interchangeably when they are quit different.

Working in Corrections as I do (Medical Doctor in a max security prison, not doing psychiatric work), I’ve adapted the rather flexible yet useful definitions for the terms as propounded by Dr. Hare’s school of thought:

Sociopaths are those whose sympathies and empathies are more aligned with non-traditional groups which tend to result in conflict with authority. For example, aligned with a gang, rather than a traditional family or religious group, or community or nation. As a result, they tend to treat others not in their gang with disdain, and may treat them like objects.

Psychopaths lack all basic empathy for others, and treats everyone like objects.

Sociopaths I can deal with pretty easily as I’m usually in a special class for them, as someone who can give them things they want, and they’re more likely to recognize me as a fellow human. As such, sympathy and empathy work in the doctor/patient relationship.

Psychopaths are tougher to deal with, and I don’t waste my time trying to be empathic or offering sympathy. Dealing with them needs to be very direct, concrete, and black and white.

Is this difficult? Showing empathy seems to be hardwired into most people; turning it off deliberately, even when doing so is a very good idea, doesn’t sound easy to do.


It’s not that tough, I just keep on my “all business” persona, which is how I conduct over 90% of my interactions with the average patient anyway.

Makes sense. Thanks!

Part of the problem in dealing with people who see others as mere props is that if you DO give them that empathic connection, they may simply see it as an opening, a weakness, a way to manipulate and/or destroy you. It becomes a game in which they try to play your humanity for their own gain.