Why Sociopathy is not a Personality Disorder

BMED report: Christopher Fisher, PhD
Mental Health, Neurofeedback

"Personality disorders are seen by professionals and researchers as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it. These patterns are inflexible and pervasive across many situations. The onset of the pattern can be traced back at least to the beginning of adulthood. To be diagnosed as a personality disorder, a behavioural pattern must cause significant distress or impairment in personal, social, and/or occupational situations."

Evidence suggests an effective treatment for anti-social personality disorder (AsPD) may be electroencephalography (QEEG). This guided neurofeedback "provides individually tailored neurotherapy sessions based on a patient’s unique EEG and comparisons to age appropriate, normative databases." Decide for yourself on conclusiveness of evidence. I'll return to opto-genetics and the general question of how brain firing patterns can be modified to treat brain disease later. 

What is sociopathy?

Most people agree, if they accept the term 'sociopathy" as meaningful, that it is, indeed, a persistent, pervasive, marked deviation of inner experience and behavior, and that it can be traced back at least to early adulthood. One consistent theme in sociopathy is a profound lack of emotional empathy as well as feelings of guilt and remorse. Due to their ability to imitate and their atypical or amoral stance, sociopaths may lie with ease.  Life is a game; their goal is to win. Self-identified sociopaths -- as a community -- endorse fundamentally different attitudes to life --  as well as views of themselves and others -- compared to neurotypicals. 

You won't find discussions of that in the DSM because it does not address sociopathy. Indeed it only addresses disorders -- not unusual or fundamentally atypical variants of personality. To get a view toward the variability of human experience seen through different eyes one has no choice but to step out of the DSM and look for a different way.  But first, I examine the final part of the definition of any personality disorder -- distress or impairment.  My argument demolishes the idea that sociopathy is a personality disorder.

Distress or Impairment of the Individual

To qualify as a PD, sociopathy or any other atypical variant of personality type must "cause significant distress or impairment in personal, social, and/or occupational situations."  The only reasonable take on this, if one considers sociopathy to be a personality disorder, is that the distress and impairment is viewed that way by all self-identified sociopaths, or those who would be reasonably labelled sociopaths once a good definition was accepted.  Many self-identified sociopaths do not regard themselves impaired or distressed in "in personal, social, and/or occupational situations."


Indeed for adults the only times the right to decide for oneself if one is impaired or not may be revoked is when individuals are

• incarcerated or otherwise part of the criminal justice system
• hospitalized for mental illness
• considered cognitively impaired 

Otherwise we are all free to decide if we are impaired or not. This right is an inseparable component of individual liberty in free, democratic societies.

High functioning sociopaths do not go to prison, can make sustainable plans for their future, regard their own safety and that of others, do not get in fights etc. Their own personal interest and intelligence motivates them to act 'pro-social' -- not because society says it is right or wrong. So a high functioning sociopath would not check off items 1,3,4,5 and 6 in the AsPD checklist at the end of this post and therefore would not qualify for this diagnosis. They would however likely check off items 2 and 7, but three out of seven criteria must be met to get this diagnosis.  That doesn't mean that items 2 and 7 are part of typical  human behavior! They are not. A similar argument can be made for all the other personality disorders in the DSM. For brevity I leave that for the reader to examine.

Distress or Impairment of Others

Sociopaths as a group tend to replace "social crimes" for acts that could lead to imprisonment. They are as a group more likely to manipulate people and to hurt with intent. The trauma resulting from the process of betrayal in intimate relationships can be hard to fathom, unless one has been through that experience. How a person reacts depends on individual resiliency and social support. Indeed there are many more web forums devoted to 'victims' or 'survivors' than to sociopaths or those in the so-called 'dark-triad' of personality. But anyone who has been wrung through that mill does not emerge unscathed.

The primary, erroneous assumption is that only two possibilities exist: either a person has one or more PDs or that person is within a normal spectrum. For instance, I quote Psychcentral: "You can read more about personality disorders or learn more about normal personality traits".[1]  

Three Alternatives not Two

The key point I am making is that only two alternatives are offered: 

• personality disorders
• normal personality traits

This proposition is presented as an unexamined fact almost everywhere on the web, and many of the traits of sociopathy are not included in 'normal'. Try a google search for yourself and see.

What if people exist -- who have a markedly different and anomalous personality structure, as well as habits, cognitions and emotional experiences in their relations to others as well as themselves -- but who do not fall into any PD category? 

If so, no wonder psychiatry has a great deal of difficulty with or even largely ignores sociopathy. In some sense it doesn't exist in medicine's collective thoughts as a fundamental variant that is neither disordered nor normal by any workable definition, because it is not included in the 'normal spectrum'. It has no where to exist.

However, it is also true that however one defines sociopaths in detail -- which I get to in following posts -- due to key aspects of their personality structure of which the main two are:

• absence of emotional empathy, remorse or guilt and second
• an anomalous relationship to morality 

-- such people are significantly more likely to fall into the PD category, end up in prison or cause harm to others than a neurotypical person.

But not all sociopaths do. There is much more to variations in personality than what is encompassed in models of disease. It's a fundamental error here. There are not two categories of personality; there are at least three.


Anti-Social Personality Disorder diagnostic:

For completeness I include the diagnostic criteria for AsPD. A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 or more of the following:

1. failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self and others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
7. lack of remorse. as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Summary

Self-identified sociopaths as a community endorse a vastly different set of attitudes to life, motivations, and views of morality -- of themselves and others --- compared to neurotypicals. Individually they will have particular traits of one or more personality disorder but many do not qualify for a diagnosis because they are not distressed or impaired.

But you won't find discussions of that in the DSM. Addressing variability of human experience, given the facts on the ground of what is known about sociopathy, must allow for non-diseased, atypical variants of personality, which do not fall into a normal range, and have never been included in a definition of 'normal' personality.

Who is DoctorSciFi

Let me end by saying that I am not a sociopath nor someone diagnosed with a personality disorder.  I am not an advocate for socios or for people who have been victimized by them. My goal is to incrementally gain understanding of sociopathy and variability in human experience by participating in web forums including those blogs "Sites we Like" on the right. 

The views I present about sociopathy and personality types are based on analyses of series of texts presented by people who choose to anonymously share their attitudes to life and experiences on the public web.  I listen, I ask questions and review historical exchanges (sometimes a decade) in the community. The next step is to put a picture together of what I have gathered thus far.

My goal is to understand it better, not to claim that I know the answers when I have just started.  One makes steps forward, then perhaps revises as needed. 

To my readers, first off I want to say I appreciate your eyeing this. I can see how it can be annoying that I go back and edit previous posts.  That's how I was trained as a scientist though: work out -- as best you can -- ideas  and empirical observations into a roughly coherent picture, write it all down, seek comments, go back and read it myself, do some more research  -- and hope the picture clarifies, congeals, some details are added, some more general themes may be observed.  I would say you see the scientific process in action.  The more recent posts are the ones more likely to be edited.


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[1] Psychcentral is a wonderful resource for the mentally ill and for those who are or have been intimates either as family members, friends or partners.