Antisocial personality disorder (ASPD) and psychopathy have similarities, and there is overlap between the two diagnoses, but the diagnosis of each of the two conditions is made differently.
Before I describe these two conditions, I want to clarify the terminology further.
In psychiatric language, ASPD, or describing a patient as “antisocial,” has nothing to do with whether one socializes with other people. Of course in everyday language, the term antisocial is often used to mean just that. In psychiatry it means to go against the rules and norms of society.
Likewise, the term psychopathy is not related to the term psychosis. Psychosis refers to a break from reality. The vast majority of psychopaths are fully aware of their actions.
Antisocial personality disorder is a diagnosis described in the DSM-IV TR, the current diagnostic manual for psychiatric diagnoses. It is a diagnosis mostly reflective of a person’s behavior.
Patients diagnosed with it may exhibit any of the following: repeated acts that violate social norms (i.e., illegal activity), deceitfulness, impulsivity, aggression/irritability, repeated disregard for the safety of self or others, irresponsibility, and lack of remorse. For the sake of brevity, I am not including the full DSM description. Click here to view the full DSM-IV TR criteria.
Psychopathy, on the other hand, is not even included in the DSM-IV TR. However, to confuse matters further, the DSM-IV TR technically considers ASPD and psychopathy to be the same entity, a point about which the fields of forensic psychiatry/psychology strongly disagree. The diagnosis of psychopathy is typically made by psychological testing, usually using an instrument called the Hare Psychopathy Checklist, Revised (PCL-R). In order to administer a Hare to a patient, a psychologist must review the person’s records and conduct a standardized interview. It is a 20-item clinical rating scale that looks not only at behavior (as the DSM does for ASPD) but also at affective (emotional) and interpersonal factors.
Wikipedia has a nice summary of psychopathy. Here is an excerpt that gives a descriptive overview:
The prototypical psychopath has deficits or deviances in several areas: interpersonal relationships, emotion, and self-control. Psychopaths gain satisfaction through antisocial behavior, and do not experience shame, guilt, or remorse for their actions.[15][16][17] Psychopaths lack a sense of guilt or remorse for any harm they may have caused others, instead rationalizing the behavior, blaming someone else, or denying it outright.[18] Psychopaths also lack empathy towards others in general, resulting in tactlessness, insensitivity, and contemptuousness. All of this belies their tendency to make a good, likable first impression. Psychopaths have a superficial charm about them, enabled by a willingness to say anything without concern for accuracy or truth. Shallow affect also describes the psychopath’s tendency for genuine emotion to be short lived and egocentric with an overall cold demeanor. Their behavior is impulsive and irresponsible, often failing to keep a job or defaulting on debts.[18] Psychopaths also have a markedly distorted sense of the potential consequences of their actions, not only for others, but also for themselves. They do not, for example, deeply recognize the risk of being caught, disbelieved or injured as a result of their behaviour.[19]
Most, but not all, people with psychopathy also have antisocial personality disorder. However, most people with antisocial personality disorder are not psychopaths. The small subset of those with psychopathy but without ASPD are the ones who become the white collar psychopaths.
This post was intended to give a brief overview of this extensive topic and is in some ways an oversimplification. In addition to the above links, here are some of other resources that you might find interesting:
Scientific American: “What ‘psychopath’ means“
The New Yorker: “Suffering Souls: The search for the roots of psychopathy“
Lorry Schoenly, PhD, RN, at Correctional Nurse . Net: “Help! My patient is a psychopath!“
Below is a YouTube video of Dr. Robert Hare (who created the PCL-R) discussing psychopathy and corporations. He includes many descriptions of psychopaths as well in the video.
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The entire topic is creepy. I think i know a couple of people who are border line psychopath/s and exhibit some anti social behavior. The lack of remorse and irresponsibility of the outcomes of their behavior is a dead give away for me. Never any self accountability and a complete refusal to look at themselves in the mirror. I wonder what creates such a human being? Something that break in their minds? trauma as a child? What creates this kind of person exactly? Or with severe cases such as murderers is it just pure evil? And does medication really “fix” someone like this?
Doc,
I can’t figure out if my husband is truly a psychopath or if it was the drugs that he was addicted too that made him psychopath? He lack remorse totally-blames everyone else for his behavior. He has caused so much pain and damage. He seldom apologizes to me for anything. It is to a point where i don’t speak with him anymore. It has taken me over five years to get here. I used to try so hard to reason with him-get him to see where he is wrong and take responsibility for his actions. It is like talking to a brick wall and i am done. Yet i remain married out of faith that maybe-just maybe he will redeem himself through Christ Jesus as he came from a lovely family who all are very spirit filled. He believes yet it seems as though he is stuck-hasn’t grown or matured much since prison? Although it is difficult to tell as we are separated. I went through hell and back with my husband. I knew him only a few short months before marriage and was blind to love. Only after our marriage i found out he was addicted to drugs and he became very abusive. I thought he was going to kill me as he threatened so many times to kill me. I had our only child at 39, and once she was born my husband seemed to be better for a short time. To make a very long story short he became very abusive and i had to run away for our lives away from him to safety. Our daughter was just a few months old at the time. I gave up everything i had- a business i had for over ten years-a car-a home-everything to run to NY from California only to come back several weeks later. Son after all of this my husband got himself involved with some people and he went along for a drive to beat up some alleged rapist whom his “friends” said raped a girlfriend and his friend ended up killing this young man in a public park while my husband sat in the car drunk. Said he didn’t know they were going to kill him-just beast him up. I don’t believe him anymore. I went to the trial, i read the transcripts, i spoke with the other families. As it turns out this young man that was murdered, in my opinion was not a rapist at all. He had consensual sex with this young woman and she cried rape because he bragged about it. My husband refuses to see any of that truth and he sat through his own trial as well. He was always bragging about killing people back in Belarus said he killed a child molester or stabbed one who tried to molest him as a child. He said he found him later in life. He confessed many horrible things to me, things that frightened me so much. I saw him the morning of this murder, not knowing anything had happened. And i thought he was acting very strange. He was very happy-excited-!!!! I’m still working through these things in my mind and heart. Can a person like this ever redeem them self? Can i ever trust him? I am safe now. Thank God! But would God forgive me if i divorced?
Cont.-
Or is the above behavior a moral issue? An issue of some how not allowing themselves to distinguish from right & wrong-good & evil, etc? That appears to me to be an issue with morals and not some failure of the mind not operating, but subconscious, which means to me is the spirit. A spirit issue.