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Revisiting the Age Old Case of Diagnostic Confusion: Sociopath vs. Psychopath

by Daniel Linder

As Robert Hare had indicated in an article 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 ofDSM-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 pleasure3-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 that 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 immediatly apparent that he is

either in some kind of trouble or he's about to make trouble for someone else. S/heappears to be a non-conformist or someone who was never able to conform. S/he

usually conjures up a 'tough guy' image that fits the DSM description, "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

me. There are no distinguishing features that call attention to differences associated

with any kind of danger. His or her dress is conventional, business-like or casual.

Chances are, there would be no reason not to trust this person.

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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 beassociated 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 a far cry from what it's like in middle-upper class suburbia. Sociopaths

might also be less intelligent as measured by traditional intelligence testinginstruments.

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 the sociopath's anti-social behavior tends to be

overt, impulsive and without forethought.

The MO of the psychopath, on the other hand is much more covertly deceptive, and is

extremely calculated and sophisticated in his or her planning. S/he does not act

impulsively and carefully plans ahead as to who s/he will prey on, how s/he will go

about it and what they are going to do to the one preyed on.

Motivation

As previously stated, the sociopath's behavior is described as acting with blatant

disregard for who is around, overtly, impulsively, that is, without fore thought,

without remorse, in ways commonly associated with anti-social behavior. It is the way

they have learned to survive in the world. If they want something, they will just take

it. If they want sex, they will rape someone, someone easy or in close proximity. If

angry, they will 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 appear

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 has contributing

drug/alcohol problems, whether they are using, dealing or both. The sociopath'smodus operandi tends to be overt and care little about exposure.

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Psychopaths usually have shorter criminal records, as fewer 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 cannot be seen or exposed.

Are these distinctions adequate enough to make two separate diagnoses or are they tobe treated as two distinct disorders?

It would seem that 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 thepersonality 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 the 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)

Psychopath

By Daniel Linder

In the mirror above the masses

Faces of predators mask

Diabolical malevolence

One driven by insatiable need

To exploit and humiliate

Seduce and trap

In his torture chamber

There's no escaping

His merciless snare

No defense againstAn unknown enemy.

Only the miracle of happenstance

Keeps this menace away.

A mutated soul

Allegedly a human being

Who can never change

Will never change enough

Can't rehabilitate

No chance for redemption

No room for risk

Or compromiseThe threat he poses

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Must be removed

He must be caught.

Taken away,

Be kept at bay

Locked away

Permanently and foreverOr be executed.