Sociopathy and antisociality: causes, symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Jun 20, 2023

In the field of psychiatry and psychotherapy, sociopathy is defined by the term “antisocial personality disorder”

It indicates a pathology that prevents the individual from adapting to the ethical and behavioral standards of his own socio-cultural community.

A sociopath can become a threat, display criminal attitudes, organize dangerous cults, and/or cause harm to themselves and others.

A person may show several signs of sociopathy, such as lack of remorse, disregard for the law, and a habit of lying and manipulation.

Characteristics of sociopathy: DSM-5 and antisocial disorder

The antisocial disorder is placed by the DSM-5 (Diagnostic Statistical Manual of Mental Disorders) within the personality disorders of cluster B.

This also includes borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

The DSM-5 provides a description of antisocial personality disorder that has many common features with sociopathy and psychopathy.

These latter pathologies are not diagnosable like antisocial personality disorder.

However, some research has found that these are specific disorders belonging to the category of antisocial disorder, with which they have several aspects in common.

Here is a list of characteristics of the sociopath:

Contempt for laws and social customs
Inability to recognize the rights of others
Inability to feel remorse or guilt
Tendency to adopt controlling, manipulative and often violent behaviors and attitudes
dishonesty: the subject lies, uses false names, defrauds others
impulsivity or inability to plan
irritability and aggression
inability to meet financial obligations or sustain ongoing employment
lack of remorse
the individual is at least 18 years old
Presence of a conduct disorder with an onset before the age of 15
antisocial behavior does not occur exclusively during a manic episode or in the course of schizophrenia
Nervousness
Tendency to anger
Poor education
Loneliness
Inability to keep a job or stay in one place for too long
Every crime committed is disorganized and spontaneous, without planning
Inability to plan often results in systematic economic dependency
Financial irresponsibility indicated, for example, by inability to provide child support and systematic accumulation of debt

Prevalence of sociopathy

Sociopathy occurs predominantly in males, with a 3:1 ratio compared to females.

The prevalence is 3% in men and 1% in women in the general population, and increases to 3-30% in the clinical setting.

In some cases, especially if combined with narcissistic disorder or borderline personality disorder, it can lead to criminal behavior.

Sociopathic personality

The feelings that antisocials experience most often are: frustration, humiliation, anger, boredom and in some cases even depressed mood.

These subjects are impulsive people, unable to organize themselves and plan for the long term. Not being able to tolerate frustration, they can also lead to the use of violence, throwing up their hands, killing, but also committing suicide.

Types of sociopaths

Generally, those affected by antisocial disorder are divided into four categories:

Common sociopaths

They are incapable of feeling shame and have distorted morals.

Very often kleptomania is also associated with this type of sociopathy.

They are people who move often and have very frequent sexual intercourse.

Alienated sociopaths

They are characterized by a very limited ability to love and above all empathize with each other, even if they are significant.

Usually, they feel misanthropy and hatred towards society. They are individuals who do not like to socialize and can in turn be divided into three other “subtypes”:

“hostile,” irritable, domineering, and always in conflict with the law
“cheated”, who tend to commit crimes because they believe that their attitude is justified by what they have suffered from society
“non-empathic”, those who know how to feel empathy and affection only for a small group of people (relationships are still tense and manipulative).

Aggressive sociopaths

They are characterized by a sadistic streak which they show at work and during sexual intercourse.

They usually seek positions of power (such as police officers but also teachers or parents) and may find it fun to torture animals.

Dissocial sociopaths

They are characterized by adapting to the rules of a group as long as they involve breaking the law.

Genetics and sociopathy

Some research seems to suggest that there is a genetic factor in sociopathy, while others point to a denied childhood or abuse.

One study, in particular, showed that 50% of sociopathic subjects inherited the disorder through their genetic makeup.

However, it is undeniable that environmental factors and other conditions may be the cause of the pathology that affects the rest of the sociopaths examined by the research.

Due to these conflicting results, to date it is not possible to identify with certainty the origin of sociopathy.

Risk factors for the sociopath

Studies performed on adopted individuals have shown that those who had adoptive parents with antisocial disorder had a high risk of developing this pathology.

Conduct disorder (before age 10) and attention deficit hyperactivity disorder (ADHD) increase an individual’s risk of developing sociopathy.

Studies focused instead on the family environment of individuals affected by sociopathy have instead found that individuals with this pathology tend to come from families with abusive or violent parents or close relatives.

Relational modalities of the sociopath

A sociopath can have different ways of approaching others.

Controlling, contemptuous and impulsive

There is almost always the tendency to claim the right to occupy certain positions, to “own” people, exercising systematic control over them.

Tends to believe that their own opinions and beliefs are the absolute truth and despises (although not always directly) the ideas of others.

Typically, these are not shy, insecure, or speechless individuals. They have difficulty managing emotional responses such as anger, impatience, or disappointment. They don’t know how to handle direct confrontation and verbally attack others by reacting hastily to these emotions.

Lovers of risk and lies

The attitude can appear overly spontaneous and courageous. Gives the impression of acting outside the reality of social norms and engages in bizarre, risky or outrageous activities, without assessing the possible repercussions.

Sociopaths can be criminals. Since they have a tendency to disregard the law and social rules, they may have a criminal record. They could be con artists, kleptomaniacs, or even murderers.

These people are “chronic liars”. They invent stories and make eccentric, unbelievable, but very convincing statements, displaying confidence and decisiveness.

Manipulative and poorly empathic

The way a human being interacts with other people is a very good indicator of sociopathy.

A disturbed person is very adept at getting his audience to do what he wants, either through charm or indirect manipulative strategies, or by more aggressive and controlling means.

The result is that the people who gravitate around him find themselves, in spite of themselves, doing as the sociopath wants. People with this personality disorder are incapable of feeling guilt or shame about their actions.

When they hurt an individual they feel no remorse. They seem completely indifferent or try to rationalize their actions.

They try to influence and dominate the people around them and have a tendency to take leadership positions or delude themselves that they do.

Romantic and social relationships of sociopaths

These individuals show no empathy and are incapable of love.

Although, in some cases, they give the impression that they care about one person or a small group, in reality they have great problems feeling emotions.

It is very likely that they have never had a healthy romantic relationship in the past.

Sociopaths have a hard time handling criticism.

They often crave approval from the rest of the group because they feel they are entitled to it.

Often the sociopath is not surrounded by many friends and does not have social relationships, because those who know him tend to distance himself.

Usually, those who live in close contact with a sociopath see their quality of life deteriorate.

Diagnosis and treatment of sociopathy

How to recognize sociopathy

However, there are some clues, clearly to be “taken with a grain of salt”, that could suggest an antisocial personality disorder and to which anyone can pay attention.

Without doubt, however, the evaluation of a specialist, in case of doubt, can clarify the situation.

Eye contact

Try to maintain good eye contact while talking to the other person and try to notice if this is returned.

In fact, sociopathic subjects often fail to sustain the direct gaze of others when they interact. They may also appear nervous or irritated.

However, even shy people sometimes react this way, so it’s very important not to jump to any conclusions.

Antisocial behaviors

Look for symptoms of sociopathic behavior which include lying, aggressive tendencies, intimidating behavior, tendencies to hurt people or animals, and excessive alcohol or drug use.

Emotional relationships

Find out about the person’s past, especially their significant relationships.

Sociopaths tend to have had many bad relationships in their past.

Of course, not just because someone hasn’t been successful in romantic relationships means that he’s a sociopath.

Ways of interacting with others

Observe how the individual interacts with people he knows.

If he doesn’t have close friends or family, it could be because relationships have deteriorated due to manipulative, aggressive, or abusive behavior.

Clearly, even in this case, it is not said that if someone has no friends is a sociopath. He may have issues with social anxiety, avoidant personality, social withdrawal, depression, etc.

Problems with the law

Sociopaths are often in trouble with the law due to their disregard for society’s rules. Although a sociopathic person will tend to lie about it.

Lack of empathy

Sociopaths also tend to lack empathy and see themselves as victims of others and society at large.

In some cases they develop forms of extreme self-pity, intolerance towards others in general, delusions of omnipotence and even mild manic tendencies.

Psychotherapy

The typical treatment used for sociopathy is geared towards the symptoms of antisocial personality disorder. Psychotherapy focusing on skill building and behavior change is prominent with this disorder.

Because sociopaths lack emotional depth, fail to make genuine connections with others, and often engage in criminal acts for personal gain, psychotherapy tends to focus on teaching behaviors that are pro-social. It uses a combination of behavior therapy, cognitive behavioral therapy, and personality modification techniques.

The Mayo Clinic recommends psychotherapy as the primary treatment modality for improving sociopathic symptoms.

Cognitive behavioral psychotherapy

Cognitive-behavioral oriented therapy shows, in particular, to these patients the cognitive distortions they implement to justify their illicit actions and any substance abuse.

Another peculiarity of this intervention is the treatment of symptoms (eg anxiety, depression) situationally associated with the antisocial disorder.

A particular type of cognitive-behavioral treatment, schema therapy, primarily addresses traumatic childhood experiences. Using the therapeutic relationship has shown a partial effectiveness with respect to the increase of empathy and social integration of these patients.

Medicines

The accredited health organization ACCG reports that the use of drugs in the treatment of sociopathy is minimally effective.

However, in cases of co-presence with additional disorders such as paranoia, anxiety, depression and substance abuse, medications are helpful in reducing these symptoms and facilitating psychotherapeutic work.

The violent nature of the sociopath often requires low-dose antipsychotic medications to further control symptoms of aggressive behavior.

In addition to anti-psychotics, mood stabilizers, anxiolytics and antidepressant drugs are also used in the treatment of sociopathy.

Anger management treatment

According to the Mayo Clinic, violence, irritability, aggression and anger are often present in the sociopath.

Even if the sociopath has minimal connection to his emotional state, he may respond to the simple construction of reward and punishment skills.

The APA (American Psychological Association) indicates that anger management programs can often offer a means of identifying the connection between emotional states and behaviors, through the consequences of actions.

This form of treatment seeks to achieve a reduction in violence in order to prevent the violation of the rights of others, as well as help the sociopath recognize their role in contributing to society effectively.

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