Psychopath

Psychopath (pronounced sahy-kuh-path)

(1) A person with a psychopathic personality, which manifests as amoral and antisocial behavior, lack of ability to love or establish meaningful personal relationships and an extreme egocentricity with a complete inability to feel guilt.  The condition is associated with a personality disorder indicated by a pattern of lying, cunning, manipulating, glibness, exploiting, heedlessness, arrogance, delusions of grandeur, carelessness, low self-control, disregard for morality, lack of acceptance of responsibility, callousness, and lack of empathy and remorse.  Such individuals can be particularly prone to destructive behavior (which can include violence and criminality although such people are a small percentage of the total number).

(2) In figurative use, a person with no moral conscience who perpetrates especially gruesome or bizarre violent acts (not accurate in a clinical sense but widely portrayed in popular culture).

(3) A person diagnosed with antisocial or dissocial personality disorder.

(4) A person diagnosed with any mental disorder (obsolete but something to be noted when handling historic medial notes).

1800s: The construct was psycho + path, a back-formation from psychopathic, used originally in German medical texts and most associated (and first noted in 1885) in the field of criminal psychology but later found to have pre-existed amongst spiritualists although in another sense.  Technically, it was an English borrowing from the German psychopatisch, the construct being psycho, from the Ancient Greek ψυχή (psukhḗ) (mind, spirit, consciousness; mental processes; the human soul; breath of life; literally, “that which breathes” or “breathing”) + πάθος (páthos) (suffering).  An 1885 Russian murder case was briefly notorious in the English-speaking world and brought the word into currency in the modern sense but it had been used in German medical literature from the early-nineteenth century.  Psychopath, psychopathography & psychopathy are nouns, psychopathic is a noun & adjective, psychopathological is an adjective and psychopathically is an adverb; the noun plural is psychopaths.

In popular culture the word "psycho" (the added -o- used to create a form meaning “person with characteristic”) is an informal reference which suggests someone is a psychopath or exhibits psychopathic tendencies.  Some sources list it as "offensive or disparaging" and it certainly is used in that sense but it's applied also in a jocular or affectionate manner.  Rarely, one suspects, are those thus described even close to being psychopaths in the clinical sense and it's often treated as a synonym for “highly strung”.  Among those either self-aware or rather dramatic, “psycho” is also used to self label.

Towards a standardized definition

Between the World Health Organization’s (WHO) International Classification of Diseases (ICD) and the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), there have always been differences although during the last two decades, there has been a general convergence in an attempt to render them at least broadly comparable.  The DSM is an interesting study in mission-creep, the 1952 slim original of 65 pages growing, by 2022’s DSM-5-TR, to a hefty tome of 1120, having morphed from a convenient tool for state hospital statistical reporting into a definitive codification of the mental condition in the form of diagnostic criteria.

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Although DSM-1 had what would now be thought a surprisingly broad category on sociopathic personality disturbances, including conditions now normalized, DSM-5 doesn’t include either psychopathy or sociopathy in their systems of categorization.  Instead, while both manuals make references to psychopaths and sociopaths, the ICD groups them in a category called dissocial personality disorder (DPD) while the DSM adopted antisocial personality disorder (ASPD).  Revisions to the DSM are compiled by a committee of clinicians which includes not only psychiatrists and psychologists but others such as sociologists.  The sociological faction argued empathy was not something that could be quantified by a doctor, that it was too subjective and that sticking to the overt traits which had been agreed upon for the ASPD definition was what should be all that is offered.  Psychopathy was therefore included under the ASPD diagnosis.

Between editions of the DSM, neither the diagnostic changes, nor the methods of decision are anything new or unusual and re-labelling is common, reflecting an increasing interest in attempts to de-stigmatize conditions.  Thus manic depressive disorder became bipolar disorder and intellectual disabilities are no longer termed mental retardation, a reaction to the abuse of clinical language in popular culture.  There is usually at least a small change in the diagnostic criteria for the diagnosis when the diagnostic label is changed but that’s just a glossy scientific veneer; ASPD is essentially the same as psychopathic personality disorder or sociopathic personality disorder, with only small changes to diagnostic criteria over the last several decades.

Curiously there is evidence to suggest the public take more care when making distinctions in the use of the terms psychopath & sociopath than many clinicians, the words by them used sometimes interchangeably to describe individuals with antisocial personality traits.  That’s not universal and while some professionals use them as synonyms, others make subtle differences in emphasis:

(1) Emphasis on Internal Factors: Some suggest psychopathy is primarily associated with innate personality traits such as lack of empathy, superficial charm, and a sense of the grandiose.  Underlying this is the argument psychopaths are born with these traits which at least implies the condition is largely biologically determined; a thing of nature.  By contrast, sociopathy is thought influenced more by external factors, such as upbringing, environment, and social learning; a thing of nurture.

(2) Focus on Antisocial Behaviors: Another school of thought suggests psychopathy is characterized by a manipulative and predatory nature, psychopaths often engaging in calculated, premeditated acts of harm and in this they tend often to be adept at mimicking emotions to manipulate others for personal gain. Under this model, sociopathy reflects more erratic and impulsive behaviors, sociopaths acting instinctually in response to immediate urges or emotional reactions and not of necessity planning their actions.

However, between clinicians there are those who find such distinctions helpful, those who find them interesting and those who think them merely speculative or even pointless.  In clinical practice, the diagnosis of antisocial personality disorder (ASPD) is typically used to encompass both psychopathy and sociopathy, as defined by the diagnostic criteria outlined in the DSM.