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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