What’s the real difference between a psychopath and a sociopath? In this post, we’re discussing Antisocial Personality Disorder (ASPD). We look past Hollywood stereotypes to break down ASPD, discover the official DSM-5-TR diagnostic criteria, explore risk factors, and learn how modern psychology differentiates between psychopathic and sociopathic tendencies. We’re dismantling the heavy mental health stigma and exploring the actual clinical reality of the ASPD spectrum. Watch now to learn more or continue reading!
You can find Antisocial Personality Disorder—or ASPD—in two diagnostic categories in the DSM-5-TR. It is listed in the Disruptive, Impulse-Control, and Conduct Disorders category, and under its primary category of Personality Disorders.
Overall, this is a diagnosis where a core feature is a lack of respect for the rights of others, and where the person struggles to abide by rules, laws, or other prosocial behaviors. ASPD will usually begin to show up in childhood, with onset often beginning around 9 years old. However, the diagnosis is not fully formed and present until the person’s late teens or early 20s. Generally, ASPD is a lifelong diagnosis, but symptoms can improve with age, and in some cases can remit.
Before we dive into this diagnosis more, we should address the stigma that surrounds it. ASPD is a highly stigmatized diagnosis. Imagine this: you’re told you are going to meet someone who is a psychopath and this is all you know about them. What would be your thoughts? Maybe it’s that they are cold, uncaring, and lack emotion? Or maybe more extreme, that you’re not safe and that they might want to murder you? Assessing the thoughts that you might have in a situation like this can help you identify what preconceived notions you may have, and any bias you may hold toward someone with ASPD.
We’ll talk about psychopathy and sociopathy more in a bit, but overall, these are now considered to be in the category of Antisocial Personality Disorder. That said, someone with ASPD is not necessarily a psychopath or a sociopath. We have to be careful to not judge people based on the ideas we have around these, how we see these terms portrayed in the media, or because of the fear we have. Instead, remember that those with ASPD have a mental health condition that is influencing their behavior. Consider that they may have had experiences in life that have influenced the way they see the world. And remember to challenge your biases, recognize they are there, and set them aside.
Of course, if we are working with someone who has a long history of unlawful behavior, we want to be careful to not excuse or dismiss those actions. We should also be careful to protect our own safety no matter what diagnosis someone has.
With a diagnosis of ASPD, the first part of the criteria is that the person must show a disregard for the rights of others, which might include violating these rights. This must begin before the age of 15. These violations include three or more of the following:
Laws & Social Norms – They may not conform to lawful behaviors and similar social norms, including performing acts that could result in arrest. Keep in mind, the person does not have to be arrested or involved with law enforcement, rather it simply needs to be an act or acts that could be grounds for arrest.
Personal Profit – The person acts for personal pleasure or profit, which can include lying, conning, having an alias, or otherwise being deceptive. These acts may be in an attempt for money, power, or sex.
Impulsivity – They might struggle to plan ahead or act in an impulsive manner. Therefore, they might make decisions in the heat of the moment and without considering the consequences of their actions. This can include a change in jobs that is sudden, or suddenly starting or ending a relationship.
Aggression – The client may have been in multiple physical fights or otherwise be aggressive and irritable. This would not include physical altercations where they are attempting to defend themselves. But, they might include acts of physical aggression toward a romantic partner or child.
Risk – They may disregard or not consider the safety of themselves and others. These acts might include high-risk substance use, sexual behaviors that are more high-risk, or driving while under the influence. This can also include the neglect of a child.
Irresponsibility – The person may display repeated acts of irresponsibility. Common places where we see these behaviors would be related to their finances and their work. Acts of irresponsibility might include abandoning a job, having lengthy periods of unemployment when jobs are available, or not paying debts or child support.
Lack of Remorse – Last, they might show a lack of remorse. In situations where they have stolen from, mistreated or hurt another person, they can be indifferent to this, or rationalize their behavior. These behaviors may be minimized, or they may attempt to explain things as the fault of the victim for being careless in some way.
Age
For someone to be diagnosed with Antisocial Personality Disorder, they must be 18 years of age or older. If they are under 18, other diagnoses should be considered instead, such as Conduct Disorder or Oppositional Defiant Disorder.
Conduct Disorder
Speaking of Conduct Disorder, to meet criteria for Antisocial Personality Disorder, they must have shown evidence for Conduct Disorder prior to the age of 15. In some cases they will have been diagnosed with Conduct Disorder, but in other cases you may need to discuss what was occurring before that age to determine if they could have been diagnosed with Conduct Disorder.
Finally, we need to be mindful of what might be driving the antisocial behaviors. If the person’s behaviors are due to another mental illness, like Schizophrenia or Bipolar Disorder, a diagnosis of Antisocial Personality Disorder may not be appropriate.
There are a few risk factors that are common with ASPD. Keep in mind that a risk factor does not mean someone will get a diagnosis. Instead, a risk factor only means that someone has a somewhat elevated chance of developing the diagnosis. At the same time, someone may have none of the risk factors for a diagnosis and still develop it.
Environment – For Antisocial Personality Disorder, the first risk factor is environmental. Those who are abused or neglected as children can be at increased risk of developing a Conduct Disorder, and then having that progress to ASPD.
Family History – Second, as with many mental health diagnoses, ASPD seems to have a genetic risk factor. Specifically, if someone has a parent with ASPD, this increases their risk of developing the diagnosis.
As we see with mental health conditions, they often exist on a spectrum of severity. Therefore, some cases of ASPD will be more extreme than others. Previously, the terms psychopath and sociopath were used to describe specific types of Antisocial Personality Disorder. Today, these terms have largely fallen out of use. That said, some do view these as subtypes of ASPD, and they are often seen as extreme forms of the disorder. While these terms are not widely used and are heavily stigmatized, there can be some value in discussing them to help understand some of the variability that we see in different presentations of ASPD.
Psychopathy
With psychopathy, these are individuals who meet criteria for ASPD but lack social skills. They might be more violent, but also more methodical. They are more likely to struggle to maintain relationships and be alone. They might lack guilt, even in situations where they have hurt a family member.
Sociopathy
As for sociopathy, they tend to be socially skilled. While they may present in a manner that is more socially appropriate, this can be more superficial. They might not necessarily be violent, but can be more likely to act impulsively or act more opportunistically. These individuals may also be more apt for risk-taking.
To reiterate though, psychopathy and sociopathy are no longer formally recognized. Not only that, but for those who do consider these dimensions of ASPD, they view ASPD as the overall category with psychopathy and sociopathy being subcategories. Furthermore, they do not see everyone with ASPD as being in one subcategory or the other, but rather that some might have more psychopathic tendencies, some with more sociopathic tendencies, and others who do not have a strong tendency one way or another, but meet criteria for ASPD.
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