Chances are that, at some point in your life, you’ve encountered someone who doesn’t seem to take any consideration for your feelings or understanding social norms. They lack an understanding of right and wrong no matter who gets hurt.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The term “sociopathy” can often be used and, sometimes, you might even find yourself in a moment of self-reflection asking, “Do I have sociopathy?”
It’s not quite that simple, though, so we talked to psychiatrist Andrew Coulter, MD, about what having sociopathy really means, how to deal with it and what to do if you think you have it.
Sociopathy is another term for antisocial personality disorder. “It’s a mental health condition where somebody persistently has difficulty engaging appropriately with social norms,” says Dr. Coulter.
The chronic nature of sociopathy, he adds, is what differentiates this condition from other, episodic mental health conditions like depression, panic attacks or bipolar disorder.
The list of common traits you might see in someone who has antisocial personality disorder, says Dr. Coulter, include:
Some with sociopathy may not realize that what they’re doing is wrong while others may simply not care. And sometimes, Dr. Coulter says, it can be both.
“There’s just a total lack of empathy or recognizing that what they’ve done has hurt someone or it’s only benefited themselves,” he says. “And sometimes they might recognize what they’re doing is wrong, they just don’t care or they justify it to themselves.”
Sociopathy can be both a learned condition and one you’re born with, says Dr. Coulter.
“These behaviors aren’t episodic in nature. They’re a chronic condition, part of a chronic way in which a person interacts with the world,” he says. “In a lot of cases, it’s something you’re born with, this personality structure or way of engaging with those around you.”
But, he adds, there are cases in which sociopathy is seen as adaptive behavior. “Someone may have grown up in a difficult environment,” he notes, “or you may see some of these traits in someone who has a chemical dependency.”
In those situations, he says, psychiatrists have to be careful with their diagnosis. “We have to look at this person and determine if this is a long-term pattern of behavior or the manifestation of something else,” he says.
It’s possible to hurt someone close to you without realizing it and once you understand it, it can be alarming. And, in some cases, you might begin to worry that you have sociopathy.
According to Dr. Coulter, the answer is probably no. “Most people with an antisocial personality disorder don’t really seek help or treatment or even recognize what they’re doing is problematic,” he points out.
“It really can be an egocentric illness because you do things without the regard for others and it benefits you this way,” he adds. “More often, people find out that they have this diagnosis when someone else tells them.”
If you do grow concerned about a long-standing pattern of behavior that’s problematic, though, Dr. Coulter advises seeking out a mental health professional for evaluation, especially if it’s causing problems in your personal life or at work.
Both psychopathy and sociopathy fall under the diagnosis of antisocial personality disorder, Dr. Coulter notes. But, he adds, that doesn’t mean they’re the same: “Most people with psychopathy meet criteria for antisocial personality disorder but not all people with antisocial personality disorder have psychopathy.”
Those with sociopathy tend to be more erratic and impulsive whereas those with psychopathy are often able to maintain the appearance of stable, normal life. “We make a diagnosis of antisocial personality disorder based heavily on behavior we can see,” he adds.
“With sociopathy, we’re often making the diagnosis based on what we or others see. With psychopathy, the diagnosis is based more on what that person is thinking and how they got to that point.”
There are no medications specifically for antisocial personality disorders, says Dr. Coulter. “When we use medication with these individuals, we’re treating aggression, hostility or a co-occurring condition like depression or alcohol use,” he says.
Psychotherapy is often recommended but that can be difficult. “For psychotherapy to be beneficial, the patient has to recognize the issue and want change,” he notes. “Unfortunately, with a condition like this, it doesn’t always pan out.”
There’s not a lot of motivation to work through a course of psychotherapy when so much of what has gotten a person with this condition to that point is a lack of self-awareness or a complete disregard for the consequences of their actions.
It can be particularly tough, Dr. Coulter says, to deal with a friend or family member who has sociopathy because of that lack of self-awareness. “You can gently recommend a psychiatric or psychological evaluation if their behavior is causing problems, especially if they’re impairing themselves as well as impairing you,” he says.
Because those with sociopathy don’t often recognize what they’re doing is wrong, he says, it’s best to set firm boundaries. “Make sure there’s a limit on how much they can intrude on your rights or limits,” he says. “Have that appropriate distance you’re comfortable with to avoid getting hurt.”