Revisiting the Age Old Case of Diagnostic Confusion: Sociopath vs. Psychopath
by Daniel Linder MFT
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 addressed his concerns regarding the direction 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 seen as separate entities with contrasting conceptual and behavioral profiles, and 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
Among the reasons given for this dramatic shift was that personality traits are difficult to measure reliably, and to streamline the assessment and diagnosis process, it will work better to agree on the behaviors that typify a disorder than on the reasons why they occur. The result was a diagnostic category with good reliability but dubious validity, a category that lacked congruence with other, well-established conceptions of psychopathy.
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! That such confusion could be a serious impediment for everyone working in the criminal justice system, and for society as well.3
My concern is that if psychopath and sociopath (ASPD) become interchangeable, we’re at risk of losing track of psychopath, that psychopath will fall through the cracks of our consciousness. While there had been some attempts to shed light on their contrast and account for their differences, clearer and more fleshed out descriptions and ‘psychopath-specific’ criteria are needed. (Maybe in the DSM-VI???) The better we understand the distinctions between the two, the better equipped we are to take care of and protect ourselves from the threat they pose. We’re much more vulnerable and much less effective in responding if we don’t know what we’re dealing with.
In an effort to be moving in that direction, Revisiting is considering a whole new set of ‘psychopathic-specific’ criteria and a more fleshed out conceptual profile by focusing in specific areas. i.e. appearance, socio-economic status, level of intelligence and education, modus operandi, etiology, motivation and criminal history.
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... (This pattern has also been referred to as ‘psychopathy’ and ‘sociopathy.’) 4
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
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
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)
Now, let’s look at their divergent contrast beginning with:
Psychopaths and sociopaths tend to look different or come across differently from one another.
Sociopaths (ASPD) are known for a looking more like “thugs,” criminals or social misfits. 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, with a cold, expressionless face, unkempt, tattooed all over his body, flashing his middle finger to the court and camera.
We can also go to other classic film characters include 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); Aileen Wuornos (Charlize Theron from Monster) is probably the best known sociopaths in the history of film. Aileen 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 and her life was the basis for the movie Monster.
Sociopaths tend to elicit the sense of threat violence and danger. Seeing them makes you want to walk the other way. They give off many clues and exhibit features that shout ‘antisocial,’ ‘non-comformist,’ defiance against the establishment and make it apparent they are living on the fringes.
Whereas psychopaths tend to look no different from you and me. They blend in with everyone else. They do not draw attention by their appearance or stand out in any way. There are no distinguishing features or clues that point to their malevolence, and therefore, you would be much more likely to be open and trusting. Their unassuming appearance enhances their ability to operate covertly.
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 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.
There are also a number of real life and 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 was 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 teenage boys, younger men on the streets, drugging, raping, murdered 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, fatally bludgeoning two women and mutilated three.
Differences in appearance have socio-economic far-reaching clinical implications. Sociopaths generally 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; live on the fringes while living and operating in mainstream society.
Level of intelligence and Education
Sociopaths are more often not well educated and deemed to be less intelligent as measured by traditional intelligence testing instruments and they tend to be less verbal - having less command of the English language.
Psychopaths tend to come from middle to upper class background, be more educated, verbal, thoughtful and intelligent. They have to know what they are doing, have tremendous command over their behavior in order to operate under everyone’s radar for as long as they do, sometimes for decades before they get caught.
Sociopaths are known to be volatile, prone to rages and emotional meltdowns; not psychologically sophisticated; act recklessly, mechanically, without hesitation or internal control, without ever flinching or even momentarily registering the gravity of their actions; do not seem to care about exposure, act do overtly; tend to be sloppier and disorganized, act spontaneously or impulsively without forethought or planning ahead, 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 psychopathy is the most dangerous of all antisocial personality disorders because the way they dissociate emotionally from their actions, regardless of the heinous nature of their actions.5 While “disassociated emotionally from their actions’ aptly applies to sociopaths as well, that is not actually what makes them more dangerous.
What makes psychopathy the most dangerous characterlogical disorder of al 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.6
Psychopaths operate in secrecy, covertly, out of the public eye. They 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 considered to be much higher functioning than their counterparts. They are known to lean towards being loners or recluses.
Etiology: Nature vs Nurture
Research and expert commentary indicate a consensus on what is believed to be the cause of sociopathy and psychopathy along the lines of nature versus nurture.
Sociopathy is believed to be more nurture rather than innate - the result of a “bad upbringing,” products of broken families, riddled by abuse, absent parents, addictions, and come from environments with much higher incidences of drugs, crime, guns and violence. “Genetics is not responsible for sociopathy.” 7 Perhaps where they lived their whole lives - that’s all they know, what they learned to do and how to be in order to survive.
Psychopaths are believed to be the result of faulty “brain wiring” – genetics - nature. 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. Their lack of remorse and inability to empathize are attributed to genetics and other differences in their brains. 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 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. This is how they learned to behave in order to survive in the world they grew up and live in.
The psychopath's motivations appear to be power driven and sadistic. S/he gets off on control, manipulation, humiliation, exploiting one’s vulnerability.
Sociopaths predominantly 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. Our prisons are filled with sociopaths/antisocial personality disorders.
There are many less psychopaths in our prisons than sociopaths. Psychopaths usually have shorter criminal records because they operate incognito and covertly. No one is around when they are terrorizing their victims and therefore are much harder to identify and apprehend.
Neither sociopath or psychopath should qualify or 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 personality disorders are not the result of extenuating circumstances or a biologically based psychotic disorder, i.e. schizophrenia or chemical imbalance, or bi-polar, and along with issues related to being on or off their medication. Their crimes were not isolated incidents. Moreover, there is a consistent history of such patterns that pose a threat of criminal behavior and harm to others.
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 get the death sentence. Here’s where the issue of capital punishment comes in.
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, discover 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 who 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 known to going to have any anxiety related to their plans or actions, whether torturing, raping, murdering, humiliating their victims. They will bring their psychopathy with them wherever they go, are smart enough to continue manipulating other prisoners and the system.
Sociopaths are to psychopaths as lions are to tigers. Both are cats, but are different animals and require different handling. Hopefully one day we will see them treated as two separate diagnoses, each with it’s own description and fitting criteria to identify them as two different animals.
- 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, 6 - How to Tell a Sociopath from a Psychopath, Understanding important
distinctions between criminal sociopaths and psychopaths; Dr Bonn
7- 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
In the mirror above the masses
Faces of predators mask
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
No chance for redemption
It’s black or white
Dark or light
Never another chance
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.