What Is a Psychopath?

Few psychology terms stir up confusion like “psychopath.” Even though it’s commonly (though incorrectly) used to describe someone who has a mental health condition, “psychopath” is not an official diagnosis. Instead, it’s an informal term often used for a condition called antisocial personality disorder (ASPD).

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not list psychopathy as an official clinical diagnosis.

The true definition of a psychopath in psychiatry refers to someone with ASPD, explains Dr. Prakash Masand, a psychiatrist and co-founder of the Centers of Psychiatric Excellence. ASPD describes a condition marked by patterns of manipulation tactics and violation of others.

ASPD

Masand says one thing that can be confusing about ASPD is the phrase “antisocial.”

“Most people might assume this describes someone who is reserved, a loner, keeps to himself, etc. However, this is not the case in ASPD,” he explains. “When we say antisocial in ASPD, it means someone who goes against society, rules, and other behaviors that are more commonplace.”

While some clinicians regard psychopathy as a more severe subtype of ASPD, the general consensus is that psychopathy falls under the umbrella of ASPD. In this article, we refer to information about ASPD.

Read on to learn more important information about ASPD, such as the signs, diagnostic criteria, and treatment options.

Since the term “psychopath” is not an official diagnosis, experts refer to the signs described under ASPD. According to Masand, some of the more common signs of ASPD can include:

• behavior that conflicts with social norms
• disregarding or violating the rights of others
• inability to distinguish between right and wrong
• difficulty with showing remorse or empathy
• tendency to lie often
• manipulating and hurting others
• recurring problems with the law
• general disregard toward safety and responsibility
• expressing anger and arrogance on a regular basis

Other possible signs of ASPD include a tendency to engage in behavior that’s reckless, impulsive, or may lead to harmful consequences.

Masand says someone exhibiting this behavior may also:

• lack deep emotional connections
• have a superficial charm about them
• be very aggressive
• get very angry sometimes

Additionally, people with ASPD may not react as if they have hurt someone, and they may be impulsive or abusive and may lack remorse. In the case of ASPD, abusive doesn’t necessarily mean violent.

In addition to the signs and behaviors, Masand says there are certain characteristics that are more prevalent in people with ASPD:

• ASPD is more common in men than women.
• Technically, to receive an ASPD diagnosis, you have to be at least 18 years old. But some children will show signs of conduct disorder, which may be an early indicator of ASPD.
• ASPD is a chronic (long-term) condition that seems to improve with age, and remittance (no longer showing signs of antisocial behavior) is possible.
• Mortality rates are higher in people with ASPD because of their behavior patterns.

Since psychopathy is not an official mental health condition, the condition experts diagnose is ASPD. This is one of four cluster B personality disorders outlined by the DSM-5, and the other three are:

• borderline personality disorder (BPD)
• histrionic personality disorder (HPD)
• narcissistic personality disorder (NPD)

Before explaining the criteria used to diagnose ASPD, it’s important to mention that diagnosing and treating ASPD presents some unique challenges.

According to Masand, ASPD can be difficult to treat because the person who needs help often doesn’t believe there is a problem with their behavior. As a result, they rarely seek treatment.

That said, according to the established guidelines used to diagnose ASPD, the behavior generally begins by age 15 or in the teenage years. However, Masand says a true ASPD diagnosis is not made until the age of 18.

“For most people, the worst of the behavior occurs in the late teen years throughout the twenties,” he explains.

Diagnostic criteria

To get a proper diagnosis, a mental health professional will conduct a full mental health evaluation. During this process, the mental health professional will evaluate a person’s:

• thoughts
• feelings
• behavior patterns
• relationships

The mental health professional will identify symptoms and compare them with the ASPD criteria in the DSM-5.

In order to receive a diagnosis of ASPD, a person must show a pattern of disregard for and violation of the rights of others. This is indicated by three or more of the following criteria, according to the DSM-5:

• failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest
• deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit
• impulsivity or failure to plan
• irritability and aggressiveness, often with physical fights or assaults
• reckless disregard for the safety of self or others
• consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations
• lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person

The mental health professional will also look at a person’s medical history. This full evaluation is a critical step since people with ASPD often have other mental health and substance use disorders.

Age

Because a true ASPD diagnosis is typically delayed until the age of 18, adolescents and teens who display similar symptoms are often evaluated for conduct disorder (CD) or oppositional defiant disorder (ODD).

Of the two behavior disorders, CD is more severe than ODD.

When determining if a child has ODD, mental health professionals will look at how they act around people they know. Typically, someone with ODD is more likely to act oppositional or defiant around family members, teachers, or a healthcare professional.

If an adolescent or teen shows an ongoing pattern of aggression toward others and regularly makes choices in opposition to the rules and social norms at home, at school, or with peers, a clinician may decide to evaluate for CD.

To receive a diagnosis of ASPD before the age of 18, a teen must also have a previous diagnosis of CD by age 15.

“Psychopath” and “sociopath” are often used interchangeably to informally describe someone with ASPD. Since sociopath is also not an official diagnosis, it typically joins psychopath under the umbrella diagnosis of ASPD. There is no clinical difference between the two terms.

Both psychopathy and sociopathy are other terms or ways to describe ASPD. The behaviors that are often seen in both tend to fall under the criteria of ASPD.

While the exact cause of ASPD is not known, researchers believe that its development may involve a combination of environmental and genetic factors.

More research needs to be done to understand the genetic aspects of ASPD. Previous research estimates that between 38 and 69 percent of cases may be hereditary.

Additionally, some of the environmental triggers of ASPD may include childhood neglect and other adverse experiences, such as childhood abuse.

ASPD may also be seen in people who previously received a diagnosis of CD or attention deficit hyperactivity disorder (ADHD).

Like the diagnostic process, treating someone with traits that fall under the ASPD diagnosis can be difficult. Typically, a doctor may recommend a combination of psychotherapy (talk therapy) and medication.

While no evidence supports that any medication or form of psychotherapy can cure ASPD, these methods may still help manage some of the symptoms, like impulsivity and aggression, and improve quality of life.

According to a 2015 review, early interventions in adolescents and teens who received a diagnosis of CD may also help prevent ASPD.

The researchers in the 2015 review also found that for some people with ASPD, the condition may improve or remit as they get older — with improvement occurring at a median age of 35. They also found that people with stronger social ties and support, such as a spouse or family, were more likely to experience remission.

Psychotherapy may be helpful in understanding how the disorder can impact your life and relationships. A mental health professional will work to develop strategies that help decrease the severity of the symptoms.

If medication is part of the treatment plan, a doctor might prescribe medications that treat related mental health conditions, such as anxiety, depression, or symptoms of aggression.

Options may include:

• antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) or bupropion
• antipsychotics
• anticonvulsants

The word “psychopath” is often informally used to describe someone with ASPD.

ASPD is notthe same as being “antisocial.” It primarily involves behavior that conflicts with social norms, as well as a general lack of disregard for others.

Despite the complexities surrounding ASPD, a mental health professional may be able to identify this condition and offer treatment that can help.

Read this article in Spanish.