Revisiting the Age Old Case of Diagnostic Confusion: Sociopath vs. Psychopath
by Daniel Linder
As Robert Hare had indicated in an article written in 1996, "The distinction between psychopathy and anti-social personality disorders is of considerable significance to the mental health and criminal justice systems. Unfortunately, it is a distinction that is often blurred, not only in the minds of many clinicians but in the latest edition of DSM-IV."
The DSM-IV has both disorders; psychopath and sociopath lumped together under 301.7: Antisocial Personality.
There is a pervasive pattern of disregard for and violation of the rights of others occurring since the age 15 years, as indicated by three (or more of the following:
1-failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2-deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3-impulsivity or failure to plan ahead
4-irritability and aggressiveness, as indicated by repeated physical fights or assaults
5-reckless disregard for safety of self or others
6-consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
While the DSM's diagnostic criteria are accurate and valid to the extent that they apply to both psychopathy and sociopathy, the failure to not provide additional criteria that would enable the clinician to more clearly distinguish between the two has unfortunate treatment implications.
There is obviously some overlap. For both sociopath and psychopath, lack of remorse, being extremely dangerous, deep, longstanding and pervasive characterological disturbance, significant family of origin dysfunction, an extremely poor prognosis, living on the fringes, alienated existences apply.
However, they are quite divergent in a number of ways. Let's think in terms of general tendencies like appearance, socio-economic status, level of intelligence and education, modus operandi, motivation and criminal history.
A sociopath (ASPD) is known to appear as if it is immediatly apparent that he is either in some kind of trouble or he's about to make trouble for someone else. S/he appears to be a non-conformist or someone who was never able to conform. S/he usually conjures up a 'tough guy' image that fits the DSM description, "failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest, irritability and aggressiveness, as indicated by repeated physical fights or assaults." Chances are you would not be inclined to trust this person.
The psychopath is known to appear to be just like anyone else. S/he could be you or me. There are no distinguishing features that call attention to differences associated with any kind of danger. His or her dress is conventional, business-like or casual. Chances are, there would be no reason not to trust this person.
Their disparate appearance tendencies have socio-economic implications. Sociopaths generally appear 'rougher' looking or street-wise, perhaps more unkempt and as if they come from blue-collar, poorer, disadvantaged backgrounds. They are more likely to appear as if they live on the fringes of society.
We might think of the psychopath's general appearance, on the other hand, to be associated with being more clean-cut, polished and a white-collar, middle-upper-class background. It's more likely that psychopaths are working and not resorting to crime to survive.
Level of intelligence and education
Continuing in an effort to flesh out sociological distinctions between the two, we may also expect the sociopaths to be less educated because of their disadvantaged background, and also be less verbal - having less command of the English language.
Having been raised in a poor, urban, drug-infested, gang and crime-ridden environment is a far cry from what it's like in middle-upper class suburbia. Sociopaths might also be less intelligent as measured by traditional intelligence testing instruments.
Psychopaths, in contrast, are known to often present as articulate, charming and charismatic.
Style/ Modus-operandi (MO)
There is a dramatic contrast between how the sociopath and psychopath operate in the world. We often see the sociopath acting out in public with 'reckless disregard for safety of self or others.' We can say the sociopath's anti-social behavior tends to be overt, impulsive and without forethought.
The MO of the psychopath, on the other hand is much more covertly deceptive, and is extremely calculated and sophisticated in his or her planning. S/he does not act impulsively and carefully plans ahead as to who s/he will prey on, how s/he will go about it and what they are going to do to the one preyed on.
As previously stated, the sociopath's behavior is described as acting with blatant disregard for who is around, overtly, impulsively, that is, without fore thought, without remorse, in ways commonly associated with anti-social behavior. It is the way they have learned to survive in the world. If they want something, they will just take it. If they want sex, they will rape someone, someone easy or in close proximity. If angry, they will become violent, they operate without any internal controls.
As previously stated, the psychopath operates covertly, is careful and methodical and selects his prey with an elaborate plan in mind. The psychopath's motivations appear to be power driven. S/he gets off on control, manipulation, humiliation, and is a master at reading and exploiting other people's vulnerability. Their crimes tend to be more ritualistic and involve torture. Compared to sociopaths, psychopaths are masters of deception while sociopaths are known to lack that kind of sophistication.
We'd expect sociopaths to have extensive criminal histories filled with assaults, robberies, rapes and murders. The overwhelming majority has contributing drug/alcohol problems, whether they are using, dealing or both. The sociopath's modus operandi tends to be overt and care little about exposure.
Psychopaths usually have shorter criminal records, as fewer people are aware of what they are doing. Since their modus operandi is of a covert nature, it's less likely they'd be arrested. They are not going to get caught as quickly. They operate covertly, making sure they cannot be seen or exposed.
Are these distinctions adequate enough to make two separate diagnoses or are they to be treated as two distinct disorders?
It would seem that there are profound treatment and diagnostic implications. While it appears that there is some overlap, there are as many, if not more differences between the two, that they are not one and the same.
As Hare stated, "An unfortunate consequence of the ambiguity inherent in the DSM-IV is likely to be a court case in which one clinician says the defendant meets the DSM-IV definition of ASPD, another clinician say he does not, and both are right! The first clinician uses only the formal diagnostic criteria whereas the second agrees that the defendant meets the formal criteria but argues that he or she dos not have the personality traits described in the 'Associated Features' section of the DSM-IV text. The failure to differentiate between psychopathy and ASPD can have serious consequences for clinicians, psychiatric patients and society as well."
"Perhaps this situation, an unfortunate and unnecessary one in my view, will be rectified in the DSM-V. Meanwhile, it is worth noting that interpersonal and affective traits are more discriminating of the construct of psychopathy than they are the socially deviant behaviors reflected in the DSM-IV criteria for ASPD."(Cooke)
By Daniel Linder
In the mirror above the masses
Faces of predators mask
One driven by insatiable need
To exploit and humiliate
Seduce and trap
In his torture chamber
There's no escaping
His merciless snare
No defense against
An unknown enemy.
Only the miracle of happenstance
Keeps this menace away.
A mutated soul
Allegedly a human being
Who can never change
Will never change enough
No chance for redemption
No room for risk
The threat he poses
Must be removed
He must be caught.
Be kept at bay
Permanently and forever
Or be executed.
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About Daniel Linder, MFT
Relationships. I was born with a keen sense about relationships, was always assessing how close and intimate people are with each other. I had a knack for relationships. The importance of relationships cuts to the core of who I am. The combination of clinical training, 25 years of professional experience treating dysfunctional, non-intimate couples and families, as well as rigorous self analysis has given me a lot to work with. I put what seemed to come naturally to me under a microscope in an effort to break the process of building healthy relationships down to concrete essentials: Understanding of Basic Principles, Communication Skills, Self-realization and Intimacy.