Revisiting the Age-Old Case of Diagnostic Confusion: Sociopath vs. Psychopath

Revisiting the Age-Old Case of Diagnostic Confusion: Sociopath vs. Psychopath 

Many forensic psychologists and criminologists use the terms sociopathy and psychopathy interchangeably. Leading experts have disagreed on whether there are meaningful differences between them.1 

In an article written in 1996, “Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion,” Robert Hare explained his concerns regarding the DSM-III when the decision was made to lump sociopathy or antisocial personality disorder 301.7 (ASPD) and psychopathy together. Up to that point, they were treated as separate entities with contrasting motivational and behavioral profiles, and diagnostic criteria. “In 1980 this tradition was broken with the publication of DSM-III when psychopathy was renamed antisocial personality disorder- was now defined by persistent violations of social norms, including lying, stealing, truancy, inconsistent work behavior and traffic arrests.” 2 

Hare suggested that a potential consequence of the ambiguity inherent in the DSM-III (IV and V as well) is likely to be a court case in which one clinician says the defendant meets the criteria for ASPD, another clinician say he does not, and both are right! Such confusion, he added, could be a serious impediment for everyone working in the criminal justice system, and for society as well.3 

Hare emphasized that psychopath and sociopath (ASPD) are different animals and treating them interchangeably puts a damper on our clinical assessment skills. If we lose track of what a psychopath is and don’t know what to look for or the client’s presentation doesn’t match the criteria for sociopath, we will not be able to make a diagnosis of psychopathic personality disorder, which can put public health and safety at risk.  

Despite Hare’s impassioned clarification, efforts to stay apprised of the differences between psychopath and sociopath and that two separate diagnoses have fallen short. Clearly, more fleshed out descriptions and ‘psychopath-specific’ criteria are needed. It’s essential that diagnosticians are clear that these are in fact two separate diagnoses.   

Let’s begin by looking at the most current DSM-V's description and diagnostic criteria for Antisocial Personality Disorder, “The essential feature of anti social personality disorder is a pervasive pattern of disregard for, and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood, as indicated by three or more of the following...” 4 (This pattern has also been previously referred to as ‘psychopathy’ and ‘sociopathy.’) 

1-  failure to conform to social norms with respect to lawful behaviors as indicated

      by repeatedly performing acts that are grounds for arrest - Not Psychopathy 

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 - Not Psychopathy 

4-  irritability and aggressiveness, as indicated by repeated physical fights or assaults -   

     Not Psychopathy 

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 - Not Psychopathy 

7-  lack of remorse and indifference when causing harm to others 

So far we can see some overlapping description and criteria that fits for both psychopathy and sociopathy); belong under the heading of Personality or Characterlogical Disorders: deep, longstanding and pervasive emotional disturbance; significant family of origin trauma and dysfunction. They both presume an extremely poor prognosis, considered to be untreatable, or not “therapy material.”  

·      reckless disregard for safety of self or others implies that both pose a threat to individuals and society; a tendency to display violent behavior. 

·      operate deceitfully, stealing, lying, conning. 

·      lack of remorse. 

·      unable to empathize. 

·      cannot form bonds, socially isolated 

·      live on the fringes (in different ways) 

However, now I’m are proposing a whole new set of ‘psychopathic-specific’ criteria and profile that focuses on specific areas: Appearance, Socio-economic Status, Level of Intelligence and Education, Modus-operandi, Etiology, Motivation and Criminal History. 


Psychopaths and sociopaths tend to look different, or come across differently from one another.     

Sociopaths (ASPD) tend to look dangerous, like thugs, social misfits or criminals. Think of Richard Allen Davis as a poster boy for sociopaths of the world. I saw TV clip of Richard Allen Davis in a courtroom, getting arraigned for the kidnap, rape and murder of Polly Class, 10, unkempt, with a cold, expressionless face and tattoos all over his body, flashing his middle finger to the court and cameras. 

We can also get an accurate take on how sociopaths behave by going to some memorable films whose lead characters were sociopaths, most notably: Travis Bickel (Robert de Niro from Taxi Driver), Max Cady – (Robert de Niro from Cape Fear), Alex Delarge (Malcolm McDowell from A Clockwork Orange (the movie) and Aileen Wuornos (Charlize Theron from Monster). Aileen (a woman) who had killied several men throughout Florida’ claiming they had all tried to rape her, while she was working as a prostitute. She was eventually executed by lethal injection. 

Sociopaths tend to elicit the sense of threat violence and danger. Seeing them makes you want to walk the other way. They tend to give off many clues and exhibit features that shout ‘antisocial,’ hateful, violent, against the establishment or other agency they feel wronged them and living on the fringes.

Psychopaths, on the other hand tend to look no different from you and me, and do not stand out in any way. Their appearance is a cover. There are no distinguishing features or clues that point to their malevolence, so therefore you would be much more likely to be open and trusting. Their unassuming appearance enhances their ability to operate covertly. Psychopathic Personality Disorder is known as the Little Red Riding Hood of disorders. By the time you realize you’re in danger, it’s too late. 

There are also a number of real-life, famous psychopathic serial killers. The list includes Richard Speck who systematically tortured a group of student nurses he kept hostage in the house for hours, leading them one-by-one to separate rooms and stabbing or strangling them to death; John Wayne Gacy whowas nicknamed "The Killer Clown" due to his affinity for dressing as "Pogo" at birthday parties, fundraisers and even during some of his murders of young boys; Jeffrey Dahmer whose crimes included picking up dozens of teenage boys and younger men on the streets, drugging, raping and murdering them, is famous for dismembering his victims and storing portions of their bodies in his freezer; Ted Bundy who killed a string of women after raping them. When discovering an unlocked door to a Florida State University sorority house, he fatally bludgeoned two women and mutilated three. 

Socio-economic status 

Differences in their appearance as described above are often tied to socio-economic status. 

Sociopaths tend to come from poorer, urban, drug-infested, gang and crime-laden, blue collar, uneducated, and disadvantaged backgrounds. 

Psychopaths tend towards a more clean-cut, polished, white-collar look, and reside in middle-upper-class suburbia; are likely to be working and not having to resort to crime to survive, and operate in mainstream society. A large part of their modus operandi is to not being how they appear. They live a secret life, “with plans for everyone” no one else knows about. Clinicians can often make the mistake of judging them according to their charm or apparent success. 

Level of intelligence and Education

Sociopaths tend to be less educated and are often viewed as less intelligent (as measured by traditional intelligence testing instruments), less verbal and having less command of the English language than psychopaths.

Psychopaths tend to be more educated, and showed higher intelligence on testing instruments, and are more thoughtful and verbal. They are known to be deliberate, calculated and to have tremendous command over their behavior, which should be of no surprise given that they operate under everyone’s radar for as long as they do, sometimes for decades before they get caught. 

Think of Aaron Sampler (Edward Norton from Primal Fear – the movie), who was brilliant enough to masquerade as a multiple personality disorder (MPD) so convincingly as to trick the prosecutor into defending him, and winning a ‘guilt by reason of insanity verdict.’ Aaron was so sophisticated that he was able to mimic emotions, and convince the prosecutor that he was a MPD.  

Modus-operandi (MO) 

Sociopaths are known to be volatile, prone to rages and emotional meltdowns; unsophisticated psychologically, act overtly, recklessly, mechanically, without hesitation or internal control, without ever flinching or registering the gravity of their actions; do not seem to care about exposure; are disorganized, act impulsively, without forethought or planning, which is why they will most likely get caught sooner and faster than psychopaths.    

In his article, How to Tell a Sociopath from a Psychopath, Dr Bonn said that what makes psychopaths dangerous is their level of psychological sophistication and intelligence, mastery of disguise and deception, and zeal when inflicting large-scale mayhem, which are often carefully planned attacks and carefully selected prey to kidnap, imprison, torture and murder. “Their crimes, whether violent or non-violent will be highly organized and generally offer few clues for authorities to pursue.5 

Psychopaths are also known for their masterful ability to sniff out and exploit others’ vulnerability. They can figure out ahead of time how to get their victims alone and what they are going to do when they get them alone. They are known to lean towards being loners or recluses.

 Etiology: Nature vs Nurture 

Research and expert commentary indicate a consensus on nature versus nurture as applied to sociopathy and psychopathy. 

Sociopathy is believed to be more nurture rather than nature (innate) – more the result of a “bad upbringing,” a product of broken families, riddled by abuse, absent parents, addictions, crime, guns and violence. “Genetics is not responsible for sociopathy.” 6 Perhapsit’s  where they lived their whole lives - that’s all they know, what they learned to do and how to be, in order to survive.  

Psychopathy is believed to be the result of nature (genetics, faulty “brain wiring”). The dysfunction and abuse in the family system they grew up in were more subtle nature. It’s not at all unusual for family members of psychopaths to have no idea how deeply disturbed their significant other is, and the horrific acts they are planning or have already committed. Psychopaths were cut off from and invisible to their parents. Their lack of remorse and inability to empathize are attributed to genetics and neurobiology. Their penchant for ritualistically torturing and humiliating their victims, and exploiting their vulnerability point to a deeper disturbance of biological origins. 


Sociopaths’ anti-social behavior is fueled by their alienation, rage, and hatred as well as being in an environment where crime and violence are the norm. If they want to rape, hurt or kill someone, they’ll do so without a second thought. It doesn’t matter to them whether they are going after children or innocent people, the pain they’re inflicting on others or the consequences of their actions, or whether anyone knows what they did or saw them. This is how they learned to behave in order to survive in the world where they grew up. 

The psychopath's motivations appear to be power driven and sadistic. Psychopaths get off on control, manipulation, humiliation, exploiting one’s vulnerability.   

Criminal History 

Sociopaths generally have extensive criminal histories filled with assaults, robberies, rapes and murders. The overwhelming majority have contributing drug/alcohol problems, whether they are using, dealing or both. Our prisons are filled with sociopaths/antisocial personality disorders

In contrast, psychopaths tend to have shorter criminal records because they operate incognito and covertly. No one is around when they are terrorizing their victims, and are therefore much harder to identify and apprehend, which is why there are many fewer psychopaths in our prisons than sociopaths. 

Closing Thoughts 

Neither sociopath nor psychopath should be considered not guilty by reason of insanity. They should never be exonerated from responsibility for their actions and the harm and suffering they cause to others because what they do and harm to others can not be attributed to extenuating circumstances or a biologically- based psychotic disorder, i.e. schizophrenia or bi-polar, or issues related to being on or off their medication as they are not typically treated by psychotropic medication. Usually, their crimes were not isolated incidents, there is an extensive history and pattern of criminal behavior.  

The whole idea behind Primal Fear was that had Aaron Sampler actually committed all of those heinous acts willfully, deliberately, with brilliant cunning and gusto, there is no doubt he would have and should have been be put away for life or executed.  

If we have to choose between psychopath and sociopath, which one had a more favorable prognosis or is more “treatable,” it would have to be sociopath. Going back to the nature/nurture issue, sociopathy is often sourced from a history of trauma, abuse, violence, addiction and emotional deprivation. Wounded souls needing healing have a better chance of somehow being reached, touched or spiritually inspired or, at some point, discovering the wonder of human connection. They are more likely to be ego-dystonic, that is, have some awareness of the problematic nature of the harm they inflict, and may exhibit some anxiety about what they’ve done.  

Not so with psychopaths whom I consider to be soulless and completely ego-syntonic all their lives; and who can’t and will never change, regardless of their punishment or time in prison. They are not going to have any anxiety related to their plans or actions, whether torturing, raping, murdering, or humiliating their victims. They will bring their psychopathy with them wherever they go, and are smart enough to continue manipulating other prisoners and the system. 

Sociopaths are to psychopaths as lions are to tigers. Both are cats, but require different handling.  


1-       How to Tell a Sociopath from a Psychopath, Understanding important

         distinctions between criminal sociopaths and psychopaths; Dr Bonn 

2, 3 - Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic

         Confusion; Robert Hare, PhD; Psychiatric Times; 1996

4 -     Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition,

         American Psychiatric Association; Library of Congress; Washington DC; 2013

         (DSM-III, 1980; DSM-IV, 2000) 

5 -     How to Tell a Sociopath from a Psychopath, Understanding important

         distinctions between criminal sociopaths and psychopaths; Dr Bonn 

6-      Psychopath Vs Sociopath: What’s the Difference?  Blog post from the

         Masterminds series produced by the Huffington Post in partnership with

         NBC’s The Blacklist


by Daniel Linder, MFT 

In the mirror above the masses

Faces of predators mask

Diabolical malevolence

Driven by an insatiable need

To murder, torture, rape

Exploit and humiliate

Seduce and trap

In his torture chamber

There's no escaping

His merciless snare

No defense against

An unknown evil

Never seen or imagined

Only the miracle of happenstance

Keeps this menace away.

A mutated soul

Allegedly a human being

Who can never change

Will never change enough

Can't rehabilitate

No chance for redemption

No compromise

It’s black or white

Dark or light

Never another chance

To terrorize


Must removed

Taken away

Be kept at bay

Locked away

Permanently and forever

Or be executed.


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About Daniel Linder, MFT

Daniel Linder

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.

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