A lot of people throw the word “sociopath” around pretty casually. But it’s not just a word reserved for serial killers. In fact, 7.6 million American adults (or 3.6% of the population) meet the standard diagnostic criteria for antisocial personality disorder, the actual name for sociopathy.
“Antisocial personality disorder (APD) is not about being unsociable or unfriendly,” Susan Masterson, PhD, a psychologist based in Lexington, Kentucky, tells Health. Think about it this way: anti = against, social = society/people. “Someone with APD is ultimately concerned with his or her own needs. Social norms and laws are mere obstacles and challenges to their goals, not barriers,” she explains.
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“Relationships are only addressed in the context of how treating others well will result in something pleasurable, or reduce something negative," she adds. "And how their behavior impacts others is only of concern if it creates a problem for them.”
To be diagnosed with APD, according to the Diagnostic and Statistical Manual of Mental Disorders V (the bible of the mental health world), someone must show impairments in personality functioning—either in terms of identity, like egocentrism or self-esteem derived from from personal gain, power, or pleasure; or self-direction, like goal-setting based on personal gratification and lacking the internal standards to conform to lawful or culturally normative ethical behavior. They would also have issues with interpersonal functioning, like a lack of empathy or concern for feelings, needs, or suffering of others; a lack of remorse after hurting or mistreating another; and an incapacity for intimate relationships.
Someone with APD would also probably be antagonistic and deceitful, using manipulation and subterfuge to influence or control others; callousness and remorseless, with a lack of concern for the feelings or problems of others or the effects their actions might have on others; aggressive and hostile; and impulsive and irresponsible, failing to consider or disregarding the consequences of their actions. It’s no wonder the disorder is also known as sociopathy (not to be confused with psychopathy; that’s different).
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As with most mental health disorders, nailing down the cause of APD is difficult—it at all possible, says Masterson. pinpointing any one cause is difficult, if at all possible. It has a lot to do with how you’re brought up. “It can run in families, but it's unclear if it's nature or nurture—a genetic disposition or learned behaviors and environmental influences—at play,” she says.
Antisocial personality disorder treatment
Treatment, unsurprisingly, is tough. “There’s no true cure for the mental and behavior issues that come with APD,” GinaMarie Guarino, a licensed mental health counselor based in New York, tells Health. “People with APD are not motivated to change their behavior; they don’t see a need to change,” she explains. “Instead, they feel that their behaviors are fine and that everyone else needs to change their own behaviors and expectations, and they’re more inclined to blame or redirect responsibility for their actions onto other figures of authority.”
Personality disorders aren’t a chemical issue, which is why there’s no medicinal answer for antisocial personality disorder (although a doctor may prescribe medication to treat overlapping mood issues). Rather, “it’s a mindset that someone carries everywhere they go and is the filter through which they base all their impressions and decisions on how to behave,” says Masterson.
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Treatment, then, revolves around managing the symptoms of the disorder and learning coping skills as well as how to deal with triggers and modify behavior.
But it’s rare that someone with APD would even seek help on their own (unless it would somehow eliminate or ameliorate a consequence, like a potential prison sentence or significant material loss, says Masterson). So the majority of people with APD remain undiagnosed and untreated. That’s why many of the APD cases you actually hear about have to do with people in the criminal justice system, says Guarino, as “therapy is often a condition of probation or parole for people with APD,” she explains.
For those who do seek help, one of the most common treatments for APD is CBT, or cognitive behavioral therapy. “CBT helps affected people learn how to slow down reaction times, reduce impulsive behavior, and incorporate consequential thinking into decision-making,” says Guarino. Any psychotherapy, though, would focus on improving conduct to reduce negative consequences in the person’s life, like “how to modify expectations to be more in line with reality, or use relaxation techniques to calm down the flare of an angry reaction when a sense of entitlement conflicts with what they’re getting out of a situation,” adds Masterson.
But there’s a major catch: Psychotherapy for APD only works if the affected person is actually motivated to change, Guarino says. “Like most mental health disorders, the desire for change must come from the person. They must have their own personal reasons for changing their behavior,” she explains. And that’s why it’s especially hard to treat someone with APD. “People with APD often do not see a problem with their behaviors, and so they don’t want to be cured,” she adds.
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