Revisiting the Age Old Case of Diagnostic Confusion:
Sociopath vs Psychopath
by Daniel Linder, MFT
As Robert Hare had indicated in an article he had 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 the 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.
Appearance
A sociopath (ASPD) is known to appear as if it is immediate apparent
that he is either in some kind of trouble or he's about to make
trouble someone else. S/he appears to be a non-conformist or someone
who was never able to conform for whatever the reason. S/he usually
conjures up a "tough guy" image that fits the DSM, 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 I, there are no distinguishing features that
call attention to differences associated with any kind of danger.
His dress is conventional, business-like or casual. Chances are
there would be no reason not to trust this person.
Socio-economic status
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 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 his anti-social behavior is extremely overt and tends
to act impulsively and fails to plan ahead.
The MO of the psychopath is completely different. The psychopath operates covertly, in secrecy and is extremely calculated and sophisticated in his planning. S/he does not act impulsively and carefully plans ahead as to who s/he will prey on and as to exactly how and what they are going to do to the people they prey on.
Motivation
As previously stated, the sociopath's behavior is described as
acting with blatant disregard for who's around, overtly, impulsively,
that is, without forethought, without remorse, in ways commonly
associated with anti-social behavior. It's they way they've learned
to survive in the world. If they want something, they'll just
take it. If they want sex, they'll rape someone, someone easy
or in close proximity. If angry, they'll 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 appears 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.
Criminal History
We'd expect sociopaths to 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. The sociopath's modus-operandi tends
to be overt and care little about exposure.
Psychopaths usually have shorter criminal records as less 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 can not 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 so as 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 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)."