How Sociopaths Are Different from Psychopaths

What Is A Psychopath?

A psychopath is someone whose antisocial personality centers on a profound lack of empathy, remorse, and genuine emotional connection, combined with superficial charm and cold, calculated, manipulative behavior.

“Psychopath” is not itself a clinical diagnosis. It describes a pattern of traits that, together with sociopathy, falls under the formal diagnosis of Antisocial Personality Disorder (ASPD) in the DSM-5.

A psychopath often presents as superficially charming yet manipulative, impulsive, and emotionally detached. They show little regard for others’ rights or feelings, and may act in calculated, exploitative ways without remorse.

Psychopaths are typically characterized by:

• A lack of empathy and emotional depth

• Manipulativeness and deceitfulness

• Impulsivity and irresponsibility

• An inability to form genuine emotional relationships

• A lack of guilt, shame, or moral conscience (Morin, 2021)

They are incapable of loyalty to individuals, groups, or social values and are often described as grossly selfish, callous, and unteachable through experience.

Psychopathy is extremely rare, with an estimated 0.5–1% of the general population meeting the criteria (Wynn et al., 2012).

It is also less common among women—around 11% of female violent offenders meet the criteria compared to 31% of male violent offenders (Grann, 2000).

In prison populations, 20–25% of inmates qualify for a psychopathy diagnosis, though only 16% of incarcerated women do (Salekin et al., 1997).

While these figures are well-documented today, psychopathy’s origins and conceptual development stretch back centuries.

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The Origins of Psychopathy

Depictions of psychopathic figures appear throughout ancient myths and literature. Medea in Greek tragedy and King Shahryar in The Book of One Thousand and One Nights are early examples (Kiehl & Hoffman, 2011).

The earliest written descriptions date back to ancient Greece. Theophrastus, a student of Aristotle, called such people “the unscrupulous” (Millon et al., 1998). He meant those lacking empathy or conscience.

In 1806, French physician Philippe Pinel described “mania sans délire” (“insanity without delirium”), highlighting irrational moral behavior without cognitive impairment.

His student Jean Etienne Dominique Esquirol later called it “la folie raisonnante” (“rational madness”) (Guggenbühl-Craig, 1999).

The English term “moral insanity” (Prichard, 1837) soon followed, describing individuals devoid of moral restraint despite appearing sane.

By the late 19th century, German psychiatrist J.L.A. Koch coined “psychopastiche” (psychopathic), meaning “suffering soul” (Hervé, 2007).

Throughout the early 20th century, definitions of psychopathy broadened.

Initially tied to moral deficiency, the so-called German School of Psychopathy expanded the term to include individuals who caused harm to themselves or others (Kiehl & Hoffman, 2011).

During the Great Depression, psychiatry used “psychopath” so loosely it encompassed anyone considered socially abnormal—including the depressed, shy, or insecure (Kiehl & Hoffman, 2011).

The concept became more refined in the 1930s–40s.

• In Psychopathic States (1942), David Henderson described psychopaths as rational individuals pursuing self-centered goals.

• In The Mask of Sanity (1941; revised 1951), Hervey Cleckley detailed interviews with institutionalized patients, identifying core psychopathic traits hidden behind a “mask” of normalcy. Cleckley’s work became foundational to modern understanding.

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From Psychopathy to ASPD

By 1952, the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) classified psychopathy as a “Sociopathic Personality Disturbance.”

Later revisions—DSM-II (1968) and DSM-III (1980), redefined and narrowed the disorder under Antisocial Personality Disorder (ASPD), emphasizing behavioral over emotional criteria.

Today, psychopathy is not listed in the DSM, though ASPD remains an active diagnosis.

Psychopathy continues to be studied through tools like Robert Hare’s Psychopathy Checklist (PCL-R), which measures traits such as manipulativeness, lack of empathy, superficial charm, and emotional coldness.

This distinction reflects a broader shift in psychology, from viewing psychopathy as a moral defect to understanding it as a complex personality disorder involving both emotional deficits and neurological differences.

Primary Vs. Secondary Psychopathy

A separate, older distinction cuts across the psychopath/sociopath split. Karpman (1948) introduced it as primary versus secondary psychopathy, later developed by Lykken (1995).

Primary psychopathy reflects a constitutional, temperamental deficit: low fear and anxiety, blunted affect, and callous-unemotional traits present from early life.

Lykken’s (1995) low-fear hypothesis explains why. Primary psychopaths have an underactive fear system, so punishment and threat cues fail to condition avoidance.

Secondary psychopathy is different. Sometimes called “neurotic” psychopathy, it is thought to arise from environmental adversity, trauma, and emotional dysregulation instead.

Secondary psychopaths tend to be more anxious, impulsive, and reactive, with antisociality as a by-product of disturbance rather than a cold constitutional deficit.

The split maps loosely onto the popular born-psychopath, made-sociopath framing above: primary psychopathy resembles the cold, low-anxiety, temperamental profile, while secondary psychopathy resembles the anxious, reactive, environmentally shaped one.

Etiology

The causes of psychopathy are not fully understood. Research links it to abnormal brain activity shaped by both genetics and early developmental problems.

Both nature and nurture play a role (Kiehl & Hoffman, 2011). A person typically has a genetic predisposition, and a poor environment then allows the disorder to manifest.

Developmental psychologist Robert Kegan (1986) proposed one mechanism for this. He argued that an abnormally slow rate of brain development leaves psychopaths frozen in time. They never grow out of the egocentricity, impulsiveness, and selfishness typical of adolescence.

How It Is Diagnosed

Diagnosing psychopathy accurately matters. The label is highly stigmatized, especially in the media, so a positive diagnosis carries real consequences for the person who receives it.

In 1980, Canadian psychologist Robert Hare developed the Psychopathy Checklist (PCL). It distilled the condition’s wide-ranging characteristics into a 20-item inventory.

Clinicians score the PCL through a semi-structured interview and a review of the person’s file. The result is a measure with direct implications for both mental health treatment and the criminal justice system.

The checklist originally distinguished two factors. Factor 1 captures the emotional and interpersonal core, such as callousness and a remorseless use of others. Factor 2 captures a chronically unstable, socially deviant lifestyle.

Clinicians score each of the 20 items from 0 (does not fit) to 2 (definitely fits). The minimum total is zero and the maximum is 40.

Hare set the diagnostic threshold at 30 or more. This excludes most people with ASPD, who are less likely to show the interpersonal and affective traits Factor 1 measures.

The tool evolved. In 2003, Hare revised the checklist, splitting the two factors into four facets (covered in the next section). This tool, the PCL-R, is what clinicians use to diagnose psychopathy today.

That same year, Hare co-authored a youth version, the PCL-YV, to assess psychopathic traits in adolescents (Forth, 2005).

Signs and Symptoms

Hare later refined the original two-factor PCL into four narrower facets, nested two-by-two within the original factors. They capture the key signs and symptoms of psychopathy:

Facet 1: Interpersonal (part of Factor 1)

1. Glib/superficial charm
2. Grandiose sense of self-worth
3. Pathological lying
4. Conning/manipulative

Facet 2: Affective (part of Factor 1)

1. Lack of remorse or guilt
2. Emotionally shallow
3. Callous/lack of empathy
4. Failure to accept responsibility for own actions

Facet 3: Lifestyle (part of Factor 2)

1. Need of stimulation/proneness to boredom
2. Parasitic lifestyle
3. Lack of realistic, long-term goals
4. Impulsivity
5. Irresponsibility

Facet 4: Antisocial (part of Factor 2)

1. Poor behavioral control
2. Early behavioral problems
3. Juvenile delinquency
4. Revocation of conditional release
5. Criminal versatility

Other traits that do not load cleanly onto a single facet include promiscuous sexual behavior and short-term marital relationships.

The PCL-R is scored from 0 to 40. Most people who score highly show traits from several facets.

And because these are 20 different items, it is also likely that two individuals who may be diagnosed with psychopathy will score very differently on each item. In other words, no two cases of psychopathy will look the same.

One individual might be a pathological liar in the corporate setting and another might live a parasitic lifestyle and be unable to maintain meaningful, emotional relationships.

Although there are several manifestations of psychopathy, a common duality among psychopaths is that of successful and unsuccessful psychopaths.

Successful Vs. Unsuccessful Psychopaths

“Successful psychopath” sounds like a contradiction. How can someone violent and emotionless succeed?

Yet a successful psychopath has intact neurological functioning. This helps them reach their goals without violence (Gao & Raine, 2010).

Their amygdalas and prefrontal cortices have normal volumes. Better executive functioning follows, which helps protect them from conviction.

These individuals often achieve real societal success. They do it by degrading employees, blaming others, or relying on deceptiveness, especially at work (Mathieu et al., 2014).

Cynthia Mathieu and colleagues studied exactly this effect in the corporate world. Psychopathic bosses negatively affect employee performance, mood, and well-being.

A higher PCL-R score in a boss predicts more employee distress and lower job satisfaction.

Unsuccessful psychopaths are different. Their brains and autonomic nervous systems show structural and functional impairments, which produces more overt offending, such as murder.

The line between the two is not always clean. Serial killers are sometimes labeled “semi-successful”: premeditated enough to evade police for a time, but not subtle enough to stay hidden forever (Gao & Raine, 2010).

This is not the only area of empirical research on psychopathy. There is also an abundance of work on genetics, brain development, and specific traits.

Empirical Research

Genetics is half of the nature-nurture equation. A twin study found that 50% of the variance in antisocial behavior is attributed to genetics. That is a big share.

The same research identified 7 genes, including 5HTT and BDNF, thought to influence brain structures linked to aggressive behavior.

One gene, MAOA, controls a protein that breaks down brain-signaling chemicals such as dopamine and serotonin. A variant of this gene is thought to contribute to psychopathic behavior.

This variant, MAOA-L, produces less of that protein. The chemicals build up, which can lead to impulsivity, mood swings, and violent tendencies (Raine, 2008).

Aim: Caspi et al. (2002) tested whether a gene linked to antisocial behavior only causes harm in combination with a hostile environment, rather than acting alone.

Method: The researchers followed 1,037 New Zealanders from birth, as part of the Dunedin cohort study. The sample was large. They tracked which boys had been maltreated in childhood, and which carried the low-activity MAOA gene variant (MAOA-L).

Results: Maltreated boys who also carried MAOA-L were far more likely to develop conduct disorder and adult antisocial, aggressive, and violent behavior. The high-activity variant protected them instead. MAOA-L carriers who were not maltreated developed largely normally.

Conclusion: The MAOA gene does little on its own. It only raises the risk of antisocial behavior against a background of early abuse, the clearest single demonstration of gene-environment interaction in this field.

Genes are not the only biological difference researchers have found. Anatomical differences show up too.

The amygdala and ventromedial prefrontal cortex (VMPFC) are both key to fear conditioning, socialization, decision-making, and moral judgment. People with psychopathy show reduced amygdala volume and roughly 22% less VMPFC gray matter (Glenn et al., 2012).

Other research has tried to debunk common misconceptions about psychopaths. One misconception is that they cannot tell right from wrong.

Researchers presented participants with 8 moral and 8 conventional scenarios and asked them to identify which were morally wrong, with no laws or rules to guide them. People with psychopathy scored better than chance (Aharoni et al., 2012).

A separate study found that psychopaths do experience regret. What sets them apart is that they do not use it to guide decision-making.

In other words, regret does not steer their choices. They can make rash decisions with no weight given to future consequences (Baskin-Sommers, 2016).

This is far from an exhaustive list. Research on psychopathy is extensive, but much about treatment remains unknown.

Treatment

No single treatment fits psychopathy. There is no clear cause, and no two cases look alike.

No one drug or therapy reliably reduces its effects. Treatments must be tailored: what helps one person may not help another.

Broadly, treatment aims to reduce substance abuse, remove ties to negative networks, and alter behavior.

Group therapy is one common approach. It is a form of psychotherapy where one or more therapists work with several people at once.

Decompression treatment is another option. It uses positive reinforcement to shape behavior, and it has reduced recidivism among violent juvenile offenders (Caldwell et al., 2001).

Few treatments for psychopathy are surefire. That does not mean rehabilitation is impossible.

Famous Psychopaths

Psychopaths’ behavior deviates so far from the norm that they fascinate us.

Fictionalized psychopaths are common protagonists on screen, and real ones often make headlines for dangerous, brutal acts.

Ted Bundy is one of the most famous. He raped and murdered at least 36 women over four years in the 1970s. But his violence alone did not make him a psychopath.

Not all psychopaths are heartless killers, and not all heartless killers are psychopaths. What set Bundy apart was his mask of sanity.

On the surface he was charming and charismatic, someone people respected and trusted. Underneath that mask was a cold-hearted killer.

Bundy showed no empathy or remorse for his crimes. He admitted to plotting them meticulously, giving little thought to his victims’ suffering, the kind of “cold-heartedness” common in psychopaths (Hirschtritt et al., 2018).

Other well-known psychopaths include Jeffrey Dahmer, who murdered and dismembered 17 men and boys, and Frank Abagnale Jr., one of the most prolific conmen in U.S. history. Tillie Klimek was a Polish serial killer; Elizabeth Holmes ran one of the largest biotech scams in history.

Fiction offers examples too.

Voldemort from Harry Potter shows no regard for others’ suffering. Patrick Bateman appears in American Psycho, and Villanelle in Killing Eve shows no empathy, guilt, or remorse for the murders she commits.

These examples share traits that set psychopathy apart from other disorders, including ASPD. The next section explains what makes ASPD distinct.

What Is A Sociopath?

• Sociopathy is also referred to as antisocial personality disorder or ASPD.
• People with this disorder don’t follow society’s norms, are deceitful in personal relationships, and are inconsiderate of the rights of others.
• Sociopaths are highly impulsive, risk-taking, and violent.
• Unlike psychopathy, in which affective and interpersonal traits are paramount, behavioral traits alone make ASPD unique.

ASPD is not a short-term disorder – it is a longstanding pattern of behavior that impairs functioning and causes distress. ASPD has been studied by numerous psychologists and clinicians.

Research generally indicates a lifetime prevalence ranging from 1-4% of the general population, but, as with psychopathy, it is less likely among women (Lenzenweger et al., 2007).

Specifically, the lifetime prevalence in men is roughly 2-4%, whereas it ranges from 0.5-1% in women (Compton et al., 2005). Put differently, males are three to five times more likely to be diagnosed with ASPD than females (Trull et al., 2010).

The Origin of Antisocial Personality Disorder

ASPD’s history is shorter than psychopathy’s. Starting in the 1940s, Lee Nelken Robbins and Sheldon and Eleanor Glueck ran separate studies on the disorder.

Their work showed continuity between childhood and adult behavioral problems. It shaped the DSM-III.

Robins (1966) studied 524 people from a child guidance clinic, first seen between 1922 and 1932, with a follow-up in the 1950s. Ninety-four met the criteria for ASPD from the start.

She concluded ASPD is chronic. It does not remit.

The Gluecks (1950) ran a parallel study. They followed 500 boys aged 10 to 17 who had been officially deemed delinquent in Massachusetts.

Follow-up interviews at ages 25, 32, and 45 found a strong link. Childhood antisocial behavior predicted adult criminality and deviant behavior.

The DSM itself evolved too. The first version, published in 1952, called this disorder sociopathic personality disturbance, split into four reactions: antisocial, dyssocial, sexual, and addiction.

More changes followed. The 1968 DSM-II listed antisocial personality among the ten personality disorders. The full term antisocial personality disorder did not appear until DSM-III in 1980.

It remains in the DSM-5, the version used to diagnose ASPD today.

Etiology

What causes ASPD? As with most disorders, it is a mix of genetic and environmental factors.

Heritability research here is limited. One study, by Qiang Fu and colleagues (2002), used an all-male Vietnam-era twin registry and found 69% of the variance attributable to genetics and 31% to environment.

Specific genetic evidence points to the 2p12 chromosomal region, and to variation in AVPR1A and the oxytocin receptor gene (OXTR) (Fragkaki et al., 2019).

Genes alone are rarely enough. They typically need to interact with the environment before the disorder shows up.

Environmental factors range from adverse childhood experiences, both physical and sexual abuse, to childhood psychopathology such as conduct disorder and ADHD (DeLisi et al., 2019).

As with psychopathy, the MAOA variant and reduced amygdala volume also raise susceptibility to ASPD (Raine, 2008).

Genes and environment both matter here. Neither the nature side nor the nurture side works alone.

DSM-5 Diagnosis: The Major Signs and Symptoms

ASPD has no dedicated checklist of its own. It is diagnosed using the DSM-5, together with a psychological evaluation and a review of the patient’s personal and medical history.

The diagnostic criteria appear below. There must be a pervasive pattern of disregard for and violation of the rights of others since age 15, shown by three or more listed traits.

1. Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest.
2. Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.
3. Impulsivity or failure to plan.
4. Irritability and aggressiveness, often with physical fights or assaults.
5. Reckless disregard for the safety of self or others.
6. Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations.
7. Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.
8. The individual is at least age 18 years.
9. Evidence of conduct disorder typically with onset before age 15 years.
10. The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder.

Antisocial personality disorder is broadly described as a pattern of socially irresponsible, exploitative, and guiltless behavior (Goodwin & Guze, 1989).

Its main symptoms include failure to conform to the law, failure to hold steady employment, manipulation, deception, and an inability to form stable relationships (Black, 2015).

ASPD itself is not diagnosed before age 18. But a patient must show evidence of conduct disorder, the childhood equivalent, before that diagnosis is made (Black, 2015).

Treatment

ASPD is hard to treat, especially with severe symptoms. It is complex, and it manifests differently in different people.

Even so, medication can help with co-occurring conditions. Second-generation antipsychotics, including risperidone and quetiapine, can treat aggressive behavior.

Anticonvulsants such as oxcarbazepine and carbamazepine can help with impulsivity (Fisher & Hany, 2019).

Psychotherapy, or talk therapy, is another option. It may cover anger and violence management, treatment for substance abuse, and treatment for other mental health conditions (“Antisocial Personality Disorder,” 2019).

The most effective approach is also the least costly: early intervention for conduct disorder in childhood (Frick, 2016).

Treating ASPD is as complex as the disorder itself. But research into both medication and therapy remains promising.

Empirical Research

Treatment is not the only research focus for ASPD. There is also plenty of empirical work on its comorbidity, prevalence, and risk factors.

One study found that, between age 5 and adolescence, males show more externalizing symptoms and females show more internalizing symptoms. This gap narrows with adolescence.

Even so, differences remain. Boys and girls show different types of antisocial behavior and aggression, and the gap persists into adulthood (Cale & Lilienfeld, 2002).

Another study looked at conduct disorder (CD) in a younger population. The goal was to predict future ASPD risk in women.

Type mattered most. Interpersonal and physical aggression, destruction of property, and the traditional diagnosis all predicted risk better than the number of behaviors present (Burnette & Newman, 2005).

IQ matters too. Morizot and Kazemian (2014) found that a lower IQ raises ASPD risk.

ASPD is impulsive by nature. It is no surprise, then, that substance use disorders are its most common comorbid condition.

The National Epidemiological Survey on Alcohol and Related Conditions, a large U.S. household survey, quantified this. People with ASPD were 7 to 8 times more likely to meet criteria for alcohol dependence than those without it.

The gap was even wider for other substances. They were also 15–17 times more likely to develop drug dependence, and 5–6 times more likely to be nicotine dependent (Trull et al., 2010).

These are only a few of many studies on this complex disorder. Scholars continue to research ASPD every day.

Famous Sociopaths

Famous sociopaths span both real life and fiction. Two notorious examples are Diane Downs and Alex DeLarge.

Downs, a rare female sociopath, murdered her daughter. She also tried to kill her two other children.

She then lied to police, claiming a man had tried to carjack her and shoot the children. That combination of violence and deceit is a key indicator of ASPD.

The case was clear-cut. Downs was convicted in 1984 and sentenced to life in prison. She has since been diagnosed with narcissistic, histrionic, and antisocial personality disorders (Payne & Hopper, 1998).

On the fictional side, Alex DeLarge is another well-known sociopath. He is the protagonist of the film A Clockwork Orange, based on Anthony Burgess’s 1962 novel of the same name.

Alex commits persistent crimes, assaulting and murdering numerous innocent people. After a short stay in prison, he is committed to a mental hospital for rehabilitative treatment (Sandi, 2016).

His actions show clear moral depravity. He feels no shame carrying out brutal acts, consistently breaks the law, struggles with drug addiction, and keeps defective social relationships.

He is manipulative, deceptive, and impulsive. At just 15 years old at the story’s start, he already meets the ASPD requirement of showing CD signs before an official diagnosis at 18 or older. Alex DeLarge is a textbook sociopath.

What Are Personality Disorders?

Personality is the way of thinking, feeling, and behaving that makes you unique. It stays relatively stable over time, unlike temporary moods (Robitz, 2018).

A personality disorder is different. It is diagnosed when a person’s thoughts, feelings, and behavior deviate from cultural norms, cause distress or impaired functioning, and persist over time (American Psychological Association, 2013).

Personality disorders shape how you see yourself and others. They affect your emotional responses, your relationships, and how you control your behavior.

Borderline personality disorder and narcissistic personality disorder are two well-known examples. This article focuses on two others: psychopathy and antisocial personality disorder.

Both affect only a tiny share of the population. Yet ASPD and psychopathy are frequently depicted in film and television, and the violence sometimes associated with them makes national news.

Because of that overlap in portrayal, the two conditions are often confused with one another.

Broadly speaking, a diagnosis of sociopathy (ASPD) is based on an individual’s behavior, whereas psychopathy includes an interpersonal and affective dimension.

A common shorthand distinguishes the two: ASPD is “hot-headed” (a quick temper, impulsive, erratic), while psychopathy is “cold-hearted” (calculating, lacking empathy or emotion). The table below sets out the fuller comparison.

Aspect	Psychopath (“born”)	Sociopath (“made” / ASPD)
Presumed origin	Largely biological or genetic	Largely environmental (adversity, trauma, poor parenting)
Temperament	Cold-headed: calculated, controlled, planful	Hot-headed: impulsive, erratic, reactive
Emotion	Profound, pervasive lack of empathy and remorse	Reduced empathy, but capable of fleeting guilt
Attachment	Unable to form genuine attachments	Can form shallow, need-driven attachments
Social functioning	Superficial charm; maintains a normal-looking life	Struggles to hold down jobs and relationships
Assessment	Hare’s PCL-R	DSM-5 ASPD criteria

Both patterns share manipulativeness, deceit, a lack of genuine empathy, and disregard for others’ rights, and both are rare. The difference is one of emphasis: psychopathy weights the interpersonal and affective core, while an ASPD diagnosis rests more on behavioral criteria alone.

Critical Evaluation

Both psychopathy and ASPD are useful clinical and research constructs, but they also carry acknowledged weaknesses.

Strengths

• Validated risk tool: as Ioannou and Greenall (2008) explain, the PCL-R is the current “gold standard” for assessing psychopathy, with strong predictive validity for reoffending. Within three years of release, 80% of people judged psychopathic on the PCL-R had violated their release conditions, versus 25% of non-psychopaths; a meta-analytic review by Hemphill et al. (1998) put the risk of reoffending at roughly three times that of non-psychopaths.
• Converging brain evidence: Raine et al. (2000) used MRI on 21 people with ASPD and found 11% less prefrontal gray matter than controls, at the time the first structural brain evidence for the disorder, and it converges with the amygdala and VMPFC findings covered above (Glenn et al., 2012).
• Explanatory economy: splitting a temperamental, low-fear “born” pathway from an environmentally driven, reactive “made” one captures real heterogeneity that a single ASPD label alone would miss.

Limitations

• Not formal diagnoses: “psychopathy” and “sociopathy” are clinical conventions, not DSM categories; the DSM-5 recognizes only ASPD. The two terms are used inconsistently across researchers and overlap heavily with each other and with ASPD, a genuine construct-validity problem.
• Correlation, not causation: brain differences correlate with APD and violence, but correlation cannot show the abnormalities cause the behavior. Raine et al. (2004) even found that prefrontal deficits may relate more to an offender’s chances of being caught than to the severity of their violence.
• A “grey” diagnosis: as Smith (2000) puts it, personality disorder is “the greyest of grey areas,” and the label can become an excuse for therapeutic neglect rather than a route to treatment. Prins (1995) warns it should never become a “dustbin” category for patients who are simply difficult or unlikeable.
• Gender bias: the criteria and instruments were developed mostly on men. Female offenders comparable to those in brain-imaging studies are rare and understudied, and reviews suggest psychopathy may be under-detected, or expressed differently, in women, so the well-known male-skewed prevalence may partly reflect how it is measured (Wynn et al., 2012).

Contemporary Research

A broader shift toward dimensional models is reshaping how ASPD is understood. This matters. Crego and Widiger (2020) reviewed how ASPD maps onto the Five-Factor Model of normal personality traits.

They concluded it is best captured as a combination of high antagonism (dishonest, manipulative, callous) and low conscientiousness (irresponsible, rash), rather than as a wholly separate category. This reframing converges with the ICD-11’s own move away from categorical personality-disorder diagnosis.

Further Reading

• Kiehl, K. A., & Buckholtz, J. W. (2010). Inside the Mind of a Psychopath. Scientific American Mind, 21(4), 22-29.
• Coid, J., Yang, M., Ullrich, S., Roberts, A., & Hare, R. D. (2009). Prevalence and correlates of psychopathic traits in the household population of Great Britain. International journal of law and psychiatry, 32(2), 65-73.
• Glenn, A. L., Johnson, A. K., & Raine, A. (2013). Antisocial personality disorder: a current review. Current psychiatry reports, 15(12), 427.

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