65 Therapists Explain Exactly How They Found Out They Had A Sociopath In Front Of Them

Sociopathy is an incredibly complex mental disorder, and it shouldn’t be confused with psychopathy. This is because experts say that sociopathy falls under the designation of “Antisocial Personality Disorder (ASPD),” the same category as psychopaths. And so people diagnosed with this disorder show signs of a lack of empathy, deceitfulness, and repeated disregard for laws.

Typically, though, they still have a lack of remorse, but may occasionally feel empathy and other emotions, even if they’re shallow or fleeting. They also tend to lie and deceive. But one thing that sets those with sociopathy apart is that they are not necessarily born with these qualities. Sociopathy has been found to stem mostly from nurture, including environmental trauma, childhood violence, or severe neglect.

But what actually sets them apart from psychopathy, which also falls under the ASPD umbrella? Well, for starters, psychopathy isn’t necessarily a disorder that someone develops. Instead, it is mainly nature rather than nurture. Most people with ASPD, specifically those exhibiting psychopathic traits, will likely show signs of it from an early age, as it is often associated with genetics or structural neurological differences.

And there are also plenty of traits that separate them from sociopathy. Mostly, they tend to be cold, calculating, and emotionally detached, as they are considered less capable of experiencing genuine empathy or forming emotional bonds with others. They can be dishonest without feeling guilt or anxiety. Instead, they may pretend to feel emotions, becoming skilled manipulators. All while a sociopath may still regret their actions.

But getting a formal ASPD diagnosis is actually quite rare. This antisocial disorder affects about 1% to 4% of the adult population. As for true psychopathy, that only applies to around 1% of the general adult population. Nonetheless, the stories indicate that, in most cases, people themselves may not even know they have ASPD, since many choose not to seek a diagnosis in the first place.

Curiously, studies also show that men are roughly 3 to 4 times more likely to meet the criteria for ASPD than women, and the traits are most prominent in early adulthood. And due to the disorder’s tendency to involve disregard for social and legal norms, it’s not entirely surprising that around 40% to 70% of incarcerated men actually meet the diagnostic criteria for ASPD.

While dealing with, diagnosing, and treating someone with ASPD isn’t exactly a foreign concept to many mental health professionals — especially those specializing in the disorder — it can still be an incredibly draining task. For starters, the realization usually comes much later after the consultations begin, as they can often fall victim to what Hervey Cleckley called “The Mask of Sanity.”

This concept, which he introduced in his 1941 book The Mask of Sanity, explains how people with ASPD may present themselves as incredibly charming and rational. They will likely mimic behaviors they’ve internalized for years in order to appear as mentally stable as possible. But normally, a small slip will actually reveal the absence of emotion behind the mask, as many of the stories in the thread mention.

Due to the eventual “mask falling” phenomenon that can occur during psychiatric treatment, very few people with ASPD actually stay in therapy after finding out they have the disorder. In fact, studies show that around 60% to 70% of patients diagnosed with ASPD end up dropping out of treatment altogether. Essentially, they may not even see their behavior as problematic because of the disorder’s ego-syntonic traits.

But truth be told, there is no “cure” for ASPD, nor is there any FDA-approved medication for it. Because of this, it is considered one of the most difficult mental health conditions to treat. But that’s not to say it’s impossible to manage. In fact, specialists might try a few different approaches, mostly focusing on managing behavior and reducing risk rather than trying to fix emotions that people with ASPD may not experience the same way.