ASPD – Anti Social Personality Disorder is the modern appellation for what used to be referred to as sociopathy and psychopathy. ASPD is not just another tag but another way to structure and conceptualise both disorders in a coherent protocol. There is ongoing debate in the psychological community about the exact differences between sociopathy and psychopathy, as well as their origins (innate vs learned) which we will explore.
ASPD is more prevalent in society than generally thought, estimated around 2-4% of the population, with large over-representation in specific populations such as executives (finance, law – 10 to 15%) all the way to prison inmates (30-35%) .
Sociopathy vs Psychopathy: Overlaps & Differences
Overlaps & co-morbidities: Sociopaths and psychopaths share multiple, rare and oft shocking traits rarely see in the wider population:
- Flagrant lack of empathy or respect for boundaries,
- Lack of remorse, extremely little change,
- Antisocial behaviour (lies, aggression, manipulation, provocation etc.)
- Tendency to manipulate others for personal gain.
As a result both can struggle to form authentic relations, learn from their mistakes or bond emotionally with sufficient generosity. However both disorders differ also in key ways:
- Origins: Psychopathy is broadly understood to be more the result of a mix of biological and genetical factors, whilst sociopathy is usually more usually tied to early trauma and neglect.
- Behaviour: Psychopaths tend to be more precise in their planning and more capable of delaying gratification. They tend to be even more calculating than socipaths and to be more in control in their antisocial behaviour. Sociopaths on the other hand tend to be more disorganised, and may lash out physically more impulsively. Psychopaths tend to be better able to blend in society with their higher control behaviour, whilst sociopaths are more likely to react explosively, emotionally, and/or without weighing up longer term consequences.
- Relations: Both clearly struggle to form relations, but here sociopaths show a bit more of a capacity to form some bonds with some people or groups, whilst psychopaths hardly feel any emotion towards anyone. The emotional life of a psychopath is quite limited, they can sometimes barely feel any emotions at all, even basic ones such as anger.
Note: ASPD also shares a very large co-morbidity with an entire other personality disorder: NPD (Narcissistic Personality Disorder), worth mentioning. In essence most ASPD (sociopath or psychopath) manifest a near perfect overlap with the traits and symptoms found in narcissists such as low empathy (or no empathy in the case of psychopaths). Most NPD symptoms (seeking power, violating boundaries, etc.) are found also in ASPD. It is common to summarise as “Every sociopath is a narcissist, but not every narcissist is a sociopath.
ASPD – Anti Social Personality Disorder: Impact on others
ASPD – Anti Social Personality Disorder is arguably the most dangerous, damaging and traumatic of all “Cluster B” personality disorders of the DSM-5, which also includes NPD, BPD, etc. The regular deceit, manipulation, hurtful conduct, as well as abusing their partners into taking more than a fair share of responsibility leads to long-term psychological damage.
ASPD is also a disorder that is notoriously slow to change or treat. ASPD individuals, sociopaths or psychopaths, show extremely low ability to take onboard feedback and change. Even in the cases when they are caught red-handed in the process of lying, or using someone to their own gain, they deny everything. Even bludgeoned into logical submission, they can still deny things. In the longer term, they show almost no ability to grow out of abusive behaviours, regardless of how many times they are exposed by the partner. And they, like narcissists, hardly never apologise.
All these manipulative behaviours, the controlling of the narrative, the relentless demands and exploitation create substantial distress in partners. The constant manipulation and blame-shifting from the ASPD tends to undermine the partner/other’s sense of morality, self-worth and general worldview. Sharing intimacy with someone who can demonstrably, hurt you without hesitation, and somehow end up blaming you for it, is profound. Unable to plan or predict, partners tend to become passive or depressed, or walk on eggshells until they cede unhealthy amounts of control in the relation. Partners typically lose self trust, and find few places or people to talk to, as the ASPD tend to ensure they enjoy a great public image.
The specific impact of ASPD may also differ whether we are considering a sociopath or psychopath. Sociopaths are more outwardly impulsive, their aggression is not just long-term manipulation it is also often instant physical assaults and attacks. Their behaviour is in this sense more predictable around certain situations and contexts. Psychopaths are colder and even more calculating, resorting less commonly to physical abuse for example (though they also do, if they feel the context is safe for them to). Their behaviour is even more opportunistic, providing even less warning.
ASPD – Anti Social Personality Disorder – Treatment and Support
ASPD is notoriously difficult to treat, if in some cases not possible at all. ASPD often finds its roots in genetics and biology of the ASPD patient meaning they cannot be “treated” in that sense. Some treatment can help manage extreme impulsiveness which can lead to serious real life consequences, but they do not treat the core disorder.
ASPD – Anti Social Personality Disorder is also famously hard to treat because ASPD patients typically refuse to attend therapy. Deep down ASPD’s typically do not want to change, or do not think it possible. Despite never-ending arguments, or catching the ASPD in the act of manipulating time and again, often time they do not change their behaviour at all and show little intent to.
If they are somehow dragged into therapy they often show themselves completely unable to engage in productive sessions. They tend to attempt to charm the therapist, whilst controlling the narrative and make themselves appear more victim than they are. Or they can deny one by one, every statement made by their partner.
In some cases, some ASPD can show a some intent for owning and changing their behaviour, in which case CBT is a common therapeutic framework to manage certain triggers and behaviours. Success varies greatly. ASPD – Anti Social Personality Disorder can also occasionally benefit from better hormonal and chemical regulation, that psychiatry and medication can prove effective at. We can provide referrals in this case.
Treatment for others:
ASPD – Anti Social Personality Disorder is often more bruising for the ASPD environment and life partners than themselves (though many socipathic profiles for example end up in jail also).
For the partners and close “others” therapy revolves around understanding ASPD better, its triggers, its drivers, in order to develop better coping mechanisms, have more realistic expectations and make better decisions.
Context as always is massively important, one ASPD partner may be highly empathic and in the long run realise in private therapy that she has to end the relation. Another may have less freedom (parent, sibling) but may benefit enormously from coping strategies shared during group therapy. Each case is unique, but the overriding themes for ASPD survivors revolve around:
- Rebuilding self-esteem: Rediscovering a fairer appraisal of the survivor’s contributions, strengths and efforts.
- Rebuilding trust: For self and others around the survivor, their ability to trust has been durably damaged and will benefit from some nurturing.
- Relearning sound boundaries: Clarify what is fair what is abuse, what are reasonable relational boundaries.
- Exploring trauma: Developing awareness around ASPD trauma and better, more productive ways to manage trauma.
Private therapy sessions, or group therapy sessions are a safe place for survivors to explore and practice better strategies to manage boundaries or communicate more effectively with ASPD individuals. Group therapy sessions are a great way for survivors to compare real-life experiences, see similar patterns and share tips or strategies. Exploring triggers, feelings and how to respond to them helps participants developing new comping skills, making better decisions and learning how to protect their mental health.
