What is a Psychopath?

And how is a psychopath different from a sociopath?
Most of us have heard both terms used interchangeably in movies, books, and the media to describe people who engage in frequent aggressive or criminal, or antisocial behavior.

Do these two terms mean the same thing or different things? Is one of them more accepted or accurate than the other? Why are there two terms at all?

First of all, let’s set the record straight: “Psychopath” or, even better, “psychopathy” is the recognized scientific and clinical term. There are hundreds of psychopathy researchers at universities and research hospitals all over the world. Many are members of an international scientific society for the study of psychopathy. Thousands of scientific research articles about psychopathy appear in psychiatry and psychology journals. Psychopathy can be accurately measured using well-validated scientific screening tools.

None of this is true about sociopathy. It is simply not a recognized scientific or clinical term. If you search for scientific articles about “sociopaths” there are only a couple dozen, mostly from the 1960s and 1970s. There are no “sociopathy” researchers or societies, and no sociopathy screening tools.

So why do so many people use the term “sociopath”—not just the media, but even some clinical psychologists and psychiatrists?

It’s mostly because the term “psychopath” makes people kind of uncomfortable.

It’s a very old term. Clinicians have recognized for years that a small subset of people in every population around the world engage in persistent antisocial behaviors, and seems to lack a conscience or prosocial emotions like empathy and remorse, and guilt, which usually motivate people to avoid harming or exploiting others.

In the early 1800s, the French physician Philippe Pinel described such people as having “manie sans délire”—insanity without delirium. Later, a German psychiatrist coined the term “psychopastiche”, or suffering soul. The psychiatrist Hervey Cleckley helped bring the term psychopath into the mainstream in the 1930s with his book The Mask of Sanity, in which he documented case studies of people with psychopathy and the symptoms that characterized them, like a cold fearless temperament, a lack of remorse or empathy, and a manipulative, deceitful interpersonal style that hides behind a mask of charm, confidence, and friendliness. Sometimes, but not always, such people are quite violent or criminal.

But the term “psychopath” has always had problems. First of all, it’s confusing. It sounds like other, unrelated terms, like “psychosis”, which refers to the inability to tell reality from imagination, such as when people have hallucinations and delusions. It also sounds like “psychopathology,” which refers to any kind of mental disorder. Finally, the term psychopathy started to fall out of favor in the mid-1900s in part because it had become very stigmatizing. It had come to connote a so-called “bad seed” theory of antisocial behavior—that someone with these traits had been born irredeemably bad, even evil.

Around that time, psychologists were learning more about all the ways the social environment affects development and behavior. So the term “sociopath” started to gain favor because it emphasized social factors, like trauma or abuse, that can cause antisocial behavior.

Still, neither term was a formal clinical diagnosis yet. That changed in 1980, when yet another term, Antisocial Personality Disorder (ASPD), was added to the Diagnostic and Statistical Manual, which psychiatrists and psychologists use to make diagnoses. The only problem? ASPD was a bit of a hodgepodge of symptoms. It focused a lot on crime, but not much on the personality traits at the core of psychopathy. There are many different reasons that people may engage in frequent antisocial or criminal behavior, some of which are unrelated to mental illness. Others are related to mental illnesses other than psychopathy, or to substance use. And not all people who are psychopathic engage in crime or violence.

Today, some people use the term “sociopath” to mean anyone with ASPD. Again, however, sociopath is not a recognized clinical or scientific term. There are also ethical reasons to avoid using it. As a culture, we recognize now how inappropriate it is to refer to people as their disorder. It used to be common to call people with schizophrenia “schizophrenics” and people with anorexia “anorectics.” But it is now widely recognized that terms like these are dehumanizing. By the same token, no one with ASPD should be called a sociopath.

It is preferable to use the term psychopathy, or psychopathic traits. Psychopathy (unlike sociopathy) is a recognized scientific and clinical description. It refers to people with abnormally low levels of empathy, concern for others, and remorse; who frequently lie to and manipulate others; and who often seem charming, bold, and friendly even while they are exploiting or stealing from, or harming others.

You may still hear forensic psychologists use the term “psychopath” to refer to people with these traits who score at least at 30 out of 40 on a screening instrument called the PCL-R that is commonly used in prisons and other institutional settings.

This is just one of many reliable screening tools psychologists have developed to assess psychopathy. Most of them assess psychopathy as a dimension, or continuum, which more accurately captures the way psychopathic traits vary across the population. Scientists are increasingly learning about the patterns of neural and cognitive dysfunction that cause these traits. Evidence about effective treatments for psychopathy are starting to emerge. Thank goodness! Although it is not an official clinical diagnosis, psychopathy is absolutely a mental disorder. And while no one is “born bad,” psychopathy does have a strong genetic component—just like schizophrenia and autism and other mental health conditions—and the first signs of it tend to emerge early in childhood (in children, the term “callous-unemotional” is often used to refer to these traits). Psychopathy affects people of all genders, cultures, and ethnicities. Nobody chooses to have it.

Even if it can be hard to feel compassion for people with psychopathy sometimes, we will all be better off if we learn to accept the scientific reality of psychopathy, treat it like the public health problem it is, and devote more public health resources to understanding it, screening for it, studying it, and treating people with it.

What causes psychopathy?

Several factors influence the development of psychopathy. Although psychopathy is clearly influenced by genetic factors, there is no “psychopathy gene.” Although some parenting interventions can improve psychopathy, psychopathy is not caused by “bad parenting.”

What are the early signs of psychopathy?

One early sign of psychopathy is an unusually fearless disposition (although people with secondary psychopathy may show high levels of anxiety). Another early sign of psychopathy is reduced interest in the rewards of social contact, including reduced eye contact and reduced social smiling. Some parents of children with psychopathy report that their children seem unusually cold or unfeeling.