A lot of people use the terms ‘psychopath and ‘sociopath’ interchangeably very loosely to describe people who behave callously. But while it is true that the two are more similar than they are different, there are some notable distinctions between them.

Right off the bat, it’s worth noting that both terms are more at home in a Hollywood crime drama than in a psychiatrist’s office. Psychopath and sociopath can be considered pop psychology terms since they do not appear in the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V), the ‘bible’ of psychiatry, as a diagnosis.

Instead, ‘psychopath’ and ‘sociopath’ are terms used to describe and sometimes differentiate people who are formally diagnosed with Antisocial Personality Disorder (ASPD).

Since the two terms are not very well and precisely defined in clinical research and the scientific literature, it’s not at all surprising that many people employ the terms rather confusingly.

What is AntiSocial Personality Disorder

Before we dive into the nuances that separate a psychopath from a sociopath, it’s worth going through what constitutes a formal ASPD diagnosis. The DSM-5 defines personality disorder in general terms as ‘an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment’.

According to the DSM-5, antisocial personality is diagnosed in people who have at least three of the following traits:

• An impaired moral conscience that leads to making decisions driven purely by one’s own desires without consideration for the needs or negative consequences imposed on others.
• A habitual and pervasive disregard or violation of the rights and considerations of others without remorse. This lack of remorse is often accompanied by rationalizing their antisocial behavior.
• An inclination for engaging in behavior which could be grounds for criminal arrest and prosecution, or which skirts the edges of the law. This may include engaging in fighting and other aggressive behavior.
• A propensity for manipulating and emotionally hurting others in ways that are not sanctioned by the law but which are nevertheless widely regarded by society as unethical, immoral, irresponsible, or in violation of social norms and expectations. This includes repeated lying, the use of aliases, and cunning others for personal gain or pleasure.A history of irresponsible behavior and difficulties meeting financial obligations.
• An inability to plan ahead, prefering to always ‘wing it’, which may lead to dangerous impulsive behavior.
• Little to no regard for the safety of others.

Individuals with an antisocial personality disorder will often act in a highly selfish, reckless, and irresponsible manner, employing deceit and sometimes physical coercion to reach their goals. Some signs of these symptoms most of the time surface before the age of 15.

Due to this pattern of behavior, individuals with antisocial personality disorder commonly suffer interpersonal, occupational, and legal difficulties. All that is to say they get into trouble a lot and often very easily, whether it’s at home with the spouse and family, at the workplace or in school, or with the law.

Keeping a job, attaining an education, maintaining a family and intimate emotional relationship with others, and, in some cases, finding stable housing may be all challenging experiences for people with ASPD. In fact, major distress or negative impact on several areas of functioning, including work, study, family life, and interpersonal relationships is a requirement for diagnosing any antisocial personality disorder — it’s that prevalent.

ASPD is rarely seen alone and is often accompanied by other comorbidities, including depression, anxiety, substance abuse, and impulse control disorders.

By one estimate, up to 47% of individuals with antisocial personality disorder have had significant contact with the criminal justice system.

What’s the difference between a psychopath and a sociopath?

Individuals with antisocial personality disorder, or ASPD, are sometimes unofficially called ‘sociopaths’. Meanwhile, psychopaths have a set of personality traits that overlap with sociopaths, chiefly aggression and lack of remorse. It’s one of the reasons why the American Psychological Association describes psychopathy as another term for ASPD. However, psychopaths can take it to the next level, since their antisocial personality traits tend to be more severe.

If you imagine ASPD as a spectrum, psychopaths lie at the very extreme. That’s because psychopathy can sometimes lead to violence, especially physically.

While sociopaths are notorious for their lack of remorse and abusive behavior, they may still be cognizant that they are doing something wrong but rationalize their behavior. Individuals with psychopathic traits have a noticeable lack of guilt and empathy, as well as a generally unstable, and deviant lifestyle. However, sociopaths are considered more ‘hot-headed’ and prone to fits of anger and rage while psychopaths are more cold and calculated.

Sociopaths also tend to be more open about their deviant behavior, often making it clear they care little to none about how others feel in reaction to their behavior whereas psychopaths are more inclined to pretend to care.

Both types of antisocial personality disorders are thought to be caused by both environmental and genetic factors. However, a growing body of evidence suggests that psychopathic traits are mostly inherited while sociopathic traits are environmental, a byproduct of traumatic childhood experiences. Psychopaths are born and sociopaths are made is a phrase that seems to resonate more and more with psychiatrists.

“Evidence indicates that psychopaths are a stable proportion of any population, can be from any segment of society, may constitute a distinct taxonomic class forged by frequency‐dependent natural selection, and that the muting of the social emotions is the proximate mechanism that enables psychopaths to pursue their self‐centered goals without feeling the pangs of guilt. Sociopaths are more the products of adverse environmental experiences that affect the autonomic nervous system and neurological development that may lead to physiological responses similar to those of psychopaths. Antisocial personality disorder is a legal/clinical label that may be applied to both psychopaths and sociopaths,” Anthony Walsh and Huei-Hsia Wu from the Department of Criminal Justice at Boise State University wrote in the journal Criminal Justice Studies.

It’s estimated that between 1% and3% of the male population and less than 1% of the female population are psychopaths. But not all that surprisingly, 20% of the American prison population meets the ‘gold standard’ for measuring psychopathy, the Psychopathy Checklist-Revised (PCL-R) developed by Canadian psychologist Robert Hare, who defined psychopaths as “social predators who charm, manipulate, and ruthlessly plow their way through life.”

Psychopaths tend to be quite intelligent compared to the general population and can be from any socio-cultural background, whereas sociopaths score lower on IQ scores and tend to come from lower socio-economic backgrounds. Psychopaths also tend to be more violent and less likely to improve (in the sense of becoming less antisocial) with age compared to sociopaths.

Although personalities like Charles Manson or Ted Bundy come to mind when people envision the prototypical ‘psycho’, in real-life individuals with psychopathic traits are far from all being cold-blooded killers. They can be entrepreneurs, CEOs, lawyers, cult leaders, or politicians who while they may exploit and manipulate others, causing suffering in the process, they may never commit any violation of the penal code.

How psychopaths and sociopaths are made

Both psychopaths and sociopaths are known for engaging in high levels of cheating, meaning they exploit others for their own advantage. All social species exhibit some traits conducive to cheating, but according to Linda Mealey, an influential American evolutionary psychologist and a professor at the College of Saint Benedict until she passed away in 2002, there is a small percentage of a population for whom cheating is a genetically mandated strategy fostered by natural selection.

According to Mealey, cheating as an obligate strategy is the result of ‘frequency-dependent, genetically-based individual differences in the use of a single (antisocial) strategy.’ Frequency-dependent refers to a mechanism of evolutionary selection by which more than one type of individual is maintained in a species due to exhibiting traits that ensure superior fitness either in the long run or when there are relatively few organisms of that type.

In a landmark study from 1995, Mealy specifically spoke about how high levels of cheating as a mating strategy allow individuals to gain copulation opportunities while avoiding the time and energy used in the normal courting process. Cheating individuals, particularly males, birth more offspring, thus passing on their genes for their deceptive strategy.

After a number of generations, the cheating strategy stops being as effective because as the cheater phenotype increases in a population, the fitness advantage of the strategy decreases. If there are too many cheaters and too few honest individuals in a population, then there are simply not enough people to exploit. The reproductive success attained through cheating is kept in check by evolutionary pressures against cheating, which is why obligate cheaters are rare — between 2% and 10% in any species, which fits with scientists’ current estimates of individuals with antisocial personality disorders among human populations.

Once the ‘cheating genes’ circulate through a population, however, they are unlikely to be eliminated, becoming what biologists commonly refer to as an evolutionarily stable strategy.

While both psychopaths and sociopaths have some genetic factors that contribute to their anti-social behavior, the latter employs a ‘cheating strategy not as clearly tied to genotype,’ Mealey said. The impulsive behavior and habitual patterns of abuse of sociopaths can be traced to a deviant history. According to Mealey and other fellow psychiatrists of note, sociopaths develop the kind of emotional calluses that psychopaths are apparently born with due to inadequate socialization and hostile childhood experiences.

Walsh and Hu write in their study, which compiled the latest scientific literature on the subject, that sociopaths may be more of a threat to society than psychopaths by virtue of their sheer number. They’re not only more numerous than psychopaths, but their numbers may be on the rise due to increasing levels of poor parenting, out-of-wedlock births, and poverty.

The combination of genes and rough upbringing may lead to irreversible changes in the brain. Research shows that psychopaths have reduced gray matter in the brain’s paralimbic system, brain regions responsible for regulating emotions and self-control, setting goals, and delaying gratification. Another study found evidence of poor connections among neural circuits in the ventromedial prefrontal cortices (vMPFC),  an area involved in empathetic decision making, suggesting that psychopaths are simply ill-equipped for basic human social emotions, such as empathy.

Can you change a psychopath or sociopath?

Individuals with antisocial personality disorders rarely seek professional counsel on their own. When they do show up for therapy, their diagnosis is hampered by their general lack of insight regarding how they may have harmed others and their tendency to deny challenges or blame others for their shortcomings. This is why collateral information from the patient’s family and other healthcare professionals can be paramount for diagnosis and later counseling, but only with the patient’s consent.

Antisocial personality disorders are highly challenging to address directly in a primary healthcare setting. But there are several strategies that may help general practitioners manage the complexities of this therapeutic relationship, according to Kimberlie Dean, Acting Head of the School of Psychiatry at the University of New South Wales, and Daria Korobanova, a researcher at the School of Psychiatry at the University of New South Wales.

In a 2015 article for MedicineToday, Dean and Korobanova make it clear that, first and foremost, safety should be a priority. Patients with antisocial behavior may present risks to both themselves and others, which is why it’s important to assess their history of violent behavior, current substance abuse and misuse patterns, and any other additional stressors that may increase the risk of violence.

Once the patient agrees to collaborate with the practitioner by at least being open to discussion, the therapist can propose potential coping skills that they could learn to improve their behavioral and affective difficulties. This ranges from simple problem-solving skills, such as addressing financial issues and employment, to exercises that help with managing impulsive behavior and minimize some of the destructive patterns.

However, beyond mental health treatments for common comorbidities, such as addiction and depression, there is limited evidence to support any effective treatment for patients with antisocial personality disorders. There may be no ‘cure’ for psychopathy or sociopathy.

Even so, the two researchers from Australia mention that although there is currently no standard treatment for patients with antisocial personality disorder, there are some options that may help patients who seek help. These include social problem skills training, dialectical behavioral therapy, emotion-regulation skills training, group-based cognitive and behavioral therapy interventions, and mentalization-based therapy.