Here and on Lovefraud.com, I’ve published chapters of a new book that shares my healing journey after leaving a sociopath/psychopath. I talk about things like co-parenting , failed support systems, and how I ultimately recovered peace and happiness despite all obstacles.
Here’s Chapter 1:
Spend time on any online forum for victims of psychopaths, sociopaths, or narcissists, and you’ll find millions of people suffering at the hands of those who just don’t care. People are played, worked over, and used every day. Our world is full of misogynists, bullies, batterers, and control freaks. They confuse us and taunt us and lure us in with irresistible magnetism. They abuse our children and post videos that cause mass outrage—like a girl throwing puppies in the river to drown. We are horrified. We are scared. We are too easily seduced.
Who are these evil people? Are they all psychopaths? Just some of them? Can someone be just a little bit psychopathic but still maybe care (for me)? What’s the difference between a psychopath and a sociopath? Or a narcissist?
Will the real psychopaths please stand up?
If you’re confused, you’re not alone. In the U.S. today, mental health diagnoses are made using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This manual helps clinicians make a diagnosis and gives them a corresponding code number for every professionally recognized disorder. For example, if your features match up with the list of criteria for Generalized Anxiety Disorder, then you get that label along with number 300.02 (F41.1) in your records. It’s more complex than that, but you get the idea.
In this manual, there are disorders that are widely considered curable and those that are considered incurable. Among the incurable are the personality disorders—including antisocial personality disorder and narcissism.
What about psychopathy? According to the DSM-5, psychopathy, sociopathy, and dyssocial personality disorders are essentially the same thing. They’re all just different names for Antisocial Personality Disorder (ASPD) 301.7 (F60.2). Those code numbers make your teeth hurt, right? So will the list of criteria for ASPD, which tells us that you have to have evidence of conduct disorder before age 15 or else you cannot make this diagnosis. Conduct disorder includes things like torturing animals or stealing. But how does a clinician get someone with ASPD to admit these things if they’re slick and have never been caught?
If you’re relying on a psychopath to tell you the truth so you can make a diagnosis, you’re kidding yourself.
Basically, ASPD is about criminal behavior. And many psychopaths aren’t criminals or at least aren’t caught.
The DSM-5 admits that there are issues with the current model for personality disorders, so the team who wrote it also put a new model in the back. The requirement for conduct disorder is still there, so it’s still closely linked to criminal behaviors. Ugh. But it does focus more on traits—like manipulative charm or deceitfulness. The bottom line? The leading experts in the U.S. are telling us that it’s really hard to figure out how to best diagnose people with ASPD or any personality disorder for that matter, and they’re working on it.
To sum it up, the clinical view of psychopathy and sociopathy is that they’re just different names for ASPD. Narcissism is separate but looks almost the same except you add a dash of “I’m ultra special” and take out a bit of the lawlessness. In fact, many of the personality disorders have overlapping features, which adds to the confusion. More on that in later chapters—for now, I want to focus more exclusively on the three that have been lumped together: psychopathy, sociopathy, and ASPD.
Our approach to personality disorders is a complex issue that impacts diagnosis and treatment on many levels. For example, all personality disorders are generally considered incurable. But some are considered treatable, or even just manageable through addressing symptoms. Examples include Obsessive Compulsive Personality Disorder (OCD) and Schizotypal Personality Disorder. Then there are the personality disorders that many consider untreatable, such as ASPD and Narcissistic Personality Disorder. These beliefs influence the number of clinicians who are willing to work with people who have personality disorders (it’s not a popular calling) and who are interested in developing new treatments for those with personality disorders (many believe it’s like banging your head up against a wall). It also influences whether and how a clinician will be paid; when a clinician puts the code number on the insurance forms for a personality disorder that is considered incurable and unmanageable, few insurance companies are going to be excited about covering care. What’s the point of paying for treatment if it will go no where, anyway? Right? Clinicians need to make a living like anyone else, so most of them who work with the general public stay as far away from personality disorders as possible. It’s particularly easy to avoid psychopaths or narcissists because most of these people will never consider therapy, anyway. And that’s fine for most clinicians, because it’s no fun to work with people who aren’t covered and who aren’t likely to feel better and then say thanks.
Psychopaths already feel great, thank you very much. And yes, a narcissist may become depressed over the empty nature of his or her superficial existence, but the chances that a narcissist will show up in therapy asking to feel less special or less accomplished are slim. You can relieve the depression, but can you change the narcissistic traits? It’s a clinical dilemma.
Or consider labeling an adult with ASPD. You’re saying this person is a criminal. I’ve seen this label misused in the homeless population. Out of desperation on a freezing cold night, a homeless man might fake a disorder to get into a mental health emergency room and stay. Do this a few times, and he’s likely to be diagnosed with ASPD for his deceitful exploitation of the system—even without proof of conduct disorder before age 15. (Clinicians misuse diagnoses all the time.) But desperate people often work the system to meet their most pressing needs. Wouldn’t you, if it was ten below and snowing? Does that deserve a diagnosis? Does that deserve the stamp of a criminal applied to that homeless man for the rest of his life? What if he served in the Vietnam War or in Iraq, which is common among homeless men? Are we serving him?
ASPD is easy to apply to someone who is acting like a pain. Someone who lies to us repeatedly, someone who is aggressive and gets in a fight in the waiting room. Clinicians (wrongly) skip over the self-reported conduct disorder before age 15 requirement because they (rightly) don’t believe they can get those answers from the client. I’m not saying it’s wrong to diagnose an aggressive, deceitful person with ASPD, I’m just saying it’s not always right. I’m also saying it’s impossible to apply this label to the many charming psychopaths among us will never act out. The hand shaking, seemingly values-driven man who smiles and notices the beautiful color of my eyes just before showing off the photos he carries of his kids. Clinicians are human and fall for all the same tricks anyone else does. And in that situation, ASPD just doesn’t feel like a fit.
Even if that man is actually the psychopath.
So there are three big challenges to the clinical perspective. First, psychopaths are the last people on earth to show up in therapy. (There’s nothing wrong with them.) Second, even if they do, the diagnostic tools are confusing and clinicians are human. Third, personality disorders are considered incurable and coverage is questionable.
This influences our clinical knowledge base. Because ultimately, clinical professionals aren’t going to invest time and money learning about a disorder that they’d rather not see.
But that leaves you vulnerable when you show up in family or couples therapy with a husband who’s a psychopath and who only showed up to frame or seduce you or play with the therapist. Or when a child is being abused by a psychopathic parent and none of the helping professionals know how to see through the charming facade because none of them have invested time learning how to.
I’d venture to say that the majority of working clinicians haven’t really studied psychopathy at all. Is that a big issue? Considering that it’s estimated to be as common as ADHD in the U.S.—one in 25 people or 12 million Americans—I’d say that it’s not just a blind spot, it’s a black hole.
Then there’s the expert perspective. Robert Hare is a leader in the field of psychopathy and has developed The Psychopathy Checklist, a way of identifying psychopaths that is completely separate from the DSM-5. I appreciate his checklist because it focuses more on personality traits and less on bad behavior. He believes that all psychopaths have ASPD but not everyone who has ASPD is a psychopath. Because you can do antisocial, criminal things even if you feel bad about it. My issues here, again, is the conduct disorder component of the ASPD diagnosis. By necessity, Hare has worked almost exclusively with criminals. But what about those who have never been caught or aren’t violent? They slip through the cracks.
Then there are sociopaths, and Martha Stout is a leader in this field. She says that the defining trait of a sociopath is that they lack a conscience and that the most universal warning sign is that they will ask for your pity. Her operating definition of a sociopath aligns neatly with Hare’s definition of a psychopath, but her stories and descriptions enable us to see sociopathic behaviors in everyday contexts. She places less emphasis on a criminal background and more emphasis on traits, such as glib and superficial charm, a charismatic glow or magnetic intensity. Like many experts, she also shares numbers. Stout claims that there are more sociopaths in the U.S. than people with anorexia, four times as many as schizophrenics, and one hundred times more than people diagnosed with colon cancer.
Staggering numbers. Do they include psychopaths? Are we talking about the same thing? Some people consider a psychopath to be an extreme form of a sociopath. Some say that psychopathy is genetic and sociopathy is learned, like from parenting or in a gang. Some say that psychopathy is about traits and sociopathy is about behavior.
My question is why we haven’t formally aligned the experts, the researchers, the clinicians, and the diagnostic manual and tools around clear definitions. It puts a stop on widespread understanding. If the American Bar Association or the National Association of Social Workers were to approve a continuing education course for professionals across the nation, would they choose to align with the leading researchers and study psychopathy or the leading clinicians and study sociopathy? What about ASPD? Which set of criteria would they promote? The old model, the new model, or The Psychopathy Checklist? Would participants spend the course debating whether evidence of criminal behaviors or conduct disorder are necessary for an ASPD diagnosis, or would they get distracted trying to figure out the difference between a psychopath and a sociopath? Which assessments should court-affiliated psychologists use to evaluate people and make recommendations to the court?
How can we develop national standards when we don’t have clear, agreed-upon definitions?
On top of that, pop psychology “celebrities” basically pick a term and stick with it, producing an ocean of materials that align with their opinion about which label is right and how the disorder looks or feels to victims. This information is an invaluable grass-roots contribution to the literature on how these disorders are manifested. But what it creates is confusion. And what’s missing is alignment. Are researchers interested in categorizing or even acknowledging these volumes of information? Are clinical programs considering the public, pop psych contribution? Is any organization casting a wide enough net to pull these elements into one clear, concise set of standards that can help us understand and protect ourselves from conscienceless people?
Ultimately, pop psych information is used most by people who look online for answers they haven’t gotten from their legal or mental health professionals. And that’s a big hole to fill. I wasn’t introduced to psychopathy in grad school except to make a quick mental link between criminals and ASPD, even in my course Psychopathology and Deviance. We didn’t talk about psychopaths. And I attended a highly reputed program at a large university. To be honest with you, I have yet to meet a single mental health professional whose core program taught them even a little about how to identify psychopaths. It’s almost like you have to be on track for the FBI just to get exposure. You have to be fascinated with criminality. Most clinicians are not. So when you are dealing with a difficult person in your life and are at a loss for answers, it’s easy to feel like you have to find your own. Once online, it’s not hard to find a quick link between your ex’s behavior and psychopathy, sociopathy, narcissism—or ASPD.
Which leads us back to the question: is my ex a psychopath?
Maybe. In a world of too many definitions for psychopath, everyone is pretty much picking the one that works for them and running with it. You can certainly do the same. But why do you need to know? If it’s for a court case, then I’d recommend hiring an expert witness who’s trained in The Psychopathy Checklist and will work with the court to have your ex formally evaluated. (I’d use the Checklist over the DSM-5 because a person can be diagnosed with ASPD without being a psychopath. You need the Checklist to determine psychopathy.) But if it’s for your own clarity, then I’d say read on. In the end, this book can empower anyone involved with a difficult person, regardless of the diagnosis. And in this muddled up world of psychopaths vs. sociopaths vs. ASPD, we could all use both of those things: clarity and empowerment.
Read Chapter Two: Labels and Lists Might Not Help.