Psychopath: signs, traits, and testing

Hearing the word psychopath may conjure up images of horror movies and serial killers because of the way our culture has stigmatized the term. 

In the clinical world too, there is debate about what exactly psychopathy is. It's certainly a group of specific personality traits, but whether it’s an actual condition is up for debate. There continues to be much discussion about the definition of a psychopath and its overlap with other psychiatric disorders, making it difficult to pin down a clear definition (Abdalla-Filho, 2020). 

At the core of many characterizations is this: a psychopath is someone who lacks empathy, remorse, and guilt. Psychopaths repeatedly engage in manipulative and violent behavior towards others (Viding, 2014). Psychopaths can sometimes be seen as shallow, and are focused on their looks, achievements, and status. 

Let’s take a closer look at what makes someone a psychopath, how it differs from related conditions, and what treatment options there are for it.

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Psychopathic personality traits include a lack of remorse, empathy, and guilt. These individuals also have a tendency towards antisocial behaviors like manipulation, aggression, and violence. 

Psychopathy alone isn’t a diagnosable psychiatric condition, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5). However, it does represent a set of symptoms that fit within other related psychiatric disorders. (Abdalla-Filho, 2020).

It’s most closely associated with antisocial personality disorder (ASPD), but only about one third of people with ASPD actually meet the criteria for psychopathy. Some researchers contest that ASPD and psychopathy are completely distinct conditions, while others consider psychopathy to be a severe form of ASPD (Fisher, 2021). 

Psychopathy vs. antisocial personality disorder

Approximately 1-4% of the general population has ASPD––a separate, but similar mental health condition. Similar to psychopathy, ASPD is characterized by a lack of remorse, criminal activity, narcissism, and causing harm to others. Men are up to five times more likely to have ASPD than women (Fisher, 2021). 

ASPD typically manifests in childhood or adolescence as a condition called conduct disorder. Indicators of conduct disorder include extreme, repetitive aggression, violence, and destructive behavior. Treatment for ASPD tends to have the most success when started early at the first signs of it (Mohan, 2020; Black, 2015). 

What’s the difference between a psychopath and a sociopath?

The difference between psychopathy and sociopathy is more of a semantic one than a clinical distinction. 

The terms are more or less used to describe the same patterns of behavior, but sociopathy is based more on environment rather than innate characteristics like in psychopaths. Definitions for personality disorders have become more streamlined in recent decades, and sociopath isn’t used much clinically anymore (Kiehl, 2011).

While there’s no precise answer to exactly what causes psychopathy, research points to a combination of genes and adverse experiences in childhood, such as sexual abuse or extreme neglect. 

Current research is getting closer to identifying the exact genes that could contribute to ASPD. The psychological condition of conduct disorder in children seems to be a risk factor for ASPD as well. Some studies have found a link between ADHD and ASPD, though others have not (Fisher, 2021; DeLisi, 2019).

The signs of a psychopath involve personality traits. Having one or even a few of these doesn’t mean someone is a psychopath. That being said, a psychopath may display these noticeable characteristics (Kiehl, 2011): 

• Superficial charm

• Manipulative

• Callousness

• Aggressive

• Impulsive

• Irresponsible

• Arrogant

• Deceitful or prone to lying

• Antisocial behavior

• Prone to criminal behavior

The signs of ASPD are similar to those for psychopathy and are slightly better defined since it’s a diagnosable condition (Kiehl, 2011). 

A person with ASPD may display traits like impulsivity, lying, irritability, aggression, responsibility, recklessness, and a lack of remorse. Aggression linked to ASPD may be more impulsive in nature and not as planned out compared to true psychopathic behavior (Azevedo, 2020). 

The traits of psychopathy and ASPD also overlap with other psychiatric conditions like narcissistic personality disorder (NPD) and borderline personality disorder  (Fisher, 2021). People with NPD display psychopathic traits like exploitation and lack of compassion, but don’t show others like aggression and deceit (Fisher, 2021). 

In BPD, people may engage in repetitive manipulation, but unlike psychopaths, are motivated by the search for reassurance from others rather than truly wanting to cause someone harm. (Fisher, 2021)

Histrionic personality disorder is another condition that manifests as repetitive manipulation, however, it has a spin towards suggestiveness and seduction (French, 2020). 

It appears that truly psychopathic personality traits stay with a person for life. Antisocial personality disorder, too, seems to be a lifelong condition, but its symptoms tend to moderate with age (Black, 2015).

There is no singular test to determine if someone is a psychopath. But there are tools that clinicians use to help with diagnosis. 

Here are the different checklists and screening tools used for psychopathy:

• Psychopathy Checklist-Revised (PCL-R): The PCL-R is the main checklist, used by mental health professionals. Whoever is being examined for psychopathy answers direct questions along with any other relevant information, such as criminal history. 

• Psychopathy Checklist: Screening Version (PCL: SV): This checklist is intended to be a self-test for screening purposes, but isn't as thorough as the PCL-R. 

• Psychopathy Checklist: Youth Version (PCL-YV): This checklist is specifically for youth. These checklists are reserved mostly for professionals in the criminal justice system (Werner, 2015; Tsang, 2015). 

According to the most recent edition of the DSM-5, psychopathy isn’t a distinct, diagnosable personality disorder. 

There are also no specific clinical tests that can confirm if someone has a psychopathic personality (Fisher, 2021). 

For a diagnosis of ASPD, which features some psychopathic traits, a healthcare provider reviews your medical history and does a physical exam. They’ll also work with you to rule out other mental health conditions like bipolar disorder or schizophrenia. If you’re under 18, healthcare professionals may explore a diagnosis of conduct disorder (Fisher, 2021). 

According to the DSM-5, criteria for ASPD includes having three or more of the following characteristics, in addition to signs of conduct disorder as a child or teen (Fisher, 2021):

• Engaging in unlawful behavior

• Repeated lying and deceitfulness for pleasure or profit

• Impulsiveness or a lack of planning

• Aggression and irritability that may escalate to physical fighting

• Disregard for the safety of self or others

• Failure to sustain work or financial responsibilities

• Lack of remorse for causing hurt, pain, or distress to others

There isn’t one main, effective treatment for psychopathic traits or ASPD, but it is possible to treat symptoms (Fisher, 2021; van den Bosch, 2018). 

In severe cases, medications are used to treat aggression and impulsivity, although no specific drug significantly helps ASPD (Khalifa, 2020). Antipsychotic medications for aggressive behavior include risperidone and selective serotonin reuptake inhibitors (SSRIs) like sertraline (brand name Zoloft).

Impulsivity related to ASPD or psychopathy can be subdued with anticonvulsant medications, such as oxcarbazepine and carbamazepine (Black, 2021). 

Unless there’s a need for hospitalization due to suicidal behavior or substance abuse, the best setting for treating ASPD is outside a hospital (Fisher, 2021). While some people with ASPD engage in psychotherapy or counseling, research doesn’t yet show that it leads to an improvement in symptoms overall (Gibbons, 2020). 

Since it’s possible to have more than one mental health issue at the same time, any other conditions in addition to ASPD shouldn’t be overlooked. Treating pre-existing conditions like ADHD or drug addiction is highly recommended (Black, 2021).

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Current version

August 17, 2021

Written by

Danielle Oaks

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.