DSM 5 Sociopath Diagnostic Definitions And Symptoms

By: Nadia Khan

Updated March 08, 2021

Medically Reviewed By: Lindi Herrin, LPC

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), which is published by the American Psychiatric Association, establishes diagnostic criteria used by mental health professionals to help give accurate diagnosis of mental health disorders.   While many psychologists and other mental health professionals believe that sociopathy and psychopathy should be classified as independent diagnoses, the DSM, which is the primary source of diagnostic criteria, does not classify them as stand-alone diagnoses. 

Rather, they are terms that are used to describe individuals, based on their symptoms, who have been diagnosed with antisocial personality disorder.  Antisocial personality disorder (ASPD) is a personality disorder that affects a person’s emotional responses and that results in an inability to care about the feelings or needs of others.  People affected by antisocial personality disorder, often referred to as either psychopath or sociopath, are generally believed to lack a sense of moral conscience.

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Criteria and Features of Antisocial Personality Disorder

According to the DSM- 5, antisocial personality disorder is defined as [a] pervasive pattern of disregard for and violation of the rights of others occurring since the age 15 years, as indicated by three (or more) of the following:

1. Failure to conform to social norms concerning lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Having no regard for the safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7. Lack of remorse, or inability to feel guilt, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another."

Many adults who have been diagnosed with antisocial personality disorder (ASPD) have a history of symptoms of conduct disorder before the age of 15 years.  Additionally, impairments in both self-perception and interpersonal personalities are present as well as pathological traits. Symptoms tend to begin in adolescence or early adulthood and continue over many years. Other symptoms someone with Antisocial Personality Disorder may exhibit are:

• Being very charming or witty in order to manipulate someone or get what they want
• Exudes a sense of superiority or arrogance
• Impulsive and prone to taking risks or engaging in dangerous behavior with little regard to how it may affect others
• Lack of empathy or feelings towards others or a situation
• May display hostile, aggressive behavior, or become violent
• Being dishonest or lying to people
• No regard or care for what is right or wrong
• Being irresponsible
• Inability to maintain healthy relationships
• Lack of regard for rules or societal norms and may have a history of criminal behavior

When someone is consistently exhibiting these symptoms, and there is cause for concern, you may wonder what's going on and seek medical help. After an initial conversation and a physical evaluation, the doctor may refer the patient to a mental health professional who will look at the following things in order to render a diagnosis of antisocial personality disorder (ASPD).

• Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning.
• One or more pathological personality traits.
• The impairments in personality are stable across time and consistent in situations.
• The personality impairments are not better understood as a normative part of a developmental stage or social environment.
• Substance use or a medical condition is not the only cause.

Once antisocial personality disorder has been diagnosed, the diagnostic evaluation moves on to determine the specific personality disorders. There are many different types of personality disorders listed in the DSM-5. Therefore, only a mental health professional who specializes in personality disorders can properly diagnose the illness and provide a treatment plan. Keep in mind that not all personality disorders require medication, and some can be treated using evidence-based therapies.

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How the DSM 5 Is Used to Diagnose a Sociopath

After a medical evaluation is performed to help rule out any possible medical conditions, a primary care provider will generally refer patients to a mental health professional for further evaluation of symptoms.  The diagnosis of antisocial personality disorder is generally based upon a psychological evaluation that explores one’s thoughts, feelings, behavior patterns, relationships, and family history. 

The DSM outlines criteria for diagnosing personality disorders, such as antisocial personality disorder.  Personality disorder symptoms are typically generally the same. The diagnostic criterion for each type, however, includes specific symptoms as well as the duration and severity of the symptoms.  Therefore, it's important to be truthful and honest about all symptoms as the information provided is used to render a diagnosis.

According to the DSM, personality disorders are organized in three clusters labeled Type A, Type B, and Type C personalities.  Antisocial personality disorder falls under Cluster B personalities, which include disorders characterized by erratic or dramatic behavior and engagement in extremely impulsive, theatrical, illegal, and promiscuous behaviors.

The expertise of the psychologist or psychiatrist also plays a significant role in the accuracy of the diagnosis. As such, it is important to research licensed mental health care professionals and look at a few of them to determine the best choice. It's best to go with someone who has extensive experience working with personality disorders. A diagnosis of a sociopath can be devastating for the family and the individual, so you want to make sure no mistakes are being made. Clinical training, licensure, and patient reviews are all good ways to research and choose a licensed psychiatrist, psychologist, therapist, or counselor.

What Is the DSM-5 Criteria and Features for a Sociopath?

The criteria used to diagnose antisocial personality disorder is the criteria used to establish someone who has sociopathic tendencies.  Sociopath is not a clinical diagnosis, but rather a term used to describe characteristics of some people with antisocial personality disorder. The following criteria are listed in the DSM 5 for a diagnosis of antisocial personality disorder:

Significant Impairments in Personality Functioning

Impairments in personality functioning can be identified by several factors.

• • Identity: Egocentrism; self-esteem derived from personal gain, power, or pleasure.
  • Self-direction: Goal setting based on personal gratification. In other words, having little-to-no regard for social standards, such as obeying the lawful or reasonable ethical behavior.

  Impairments in interpersonal functioning can include the following:

  • Empathy: Lack of concern for feelings, needs, or suffering of others. Lack of remorse after hurting or mistreating another.
  • Intimacy: Incapable of mutually intimate relationships, as exploitation is a primary means of relating to others. This is normally recognized by deceitful behavior or intimidation to control others.

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Pathological Personality Traits in the Following Domains

Antagonism can be characterized by the following.

• Manipulation: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one's ends.
• Deceitfulness: Dishonesty and fraudulence; misrepresentations of self; in other words, stretching the truth when relating events.
• Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one's own actions on others; aggression; sadism.
• Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; inconsiderate, spiteful, or vengeful.

Lack of Inhibition can be characterized by the following.

• Irresponsibility; Disregard for-and failure to honor-financial and other obligations or commitments; lack of respect for-and lack of follow-through on agreements and promises.
• Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of possible outcomes; difficulty establishing and following through with plans.
• Risk-taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom, proneness, and thoughtless initiation of activities to counter boredom; lack of concern for one's limitations and denial of the reality of the personal danger.

The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations. The impairments in personality functions and the individual's personality trait expressions are not better understood as normative for the individual's developmental stage or socio-cultural environment.

The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (drug abuse, medication) or a general medical condition (head injury, trauma). The individual must be at least 18 years of age to be taken into serious consideration for the condition.

Are Antisocial Personality Disorder and Narcissistic Personality Disorder Related?

Narcissists personality disorder (NPD) and antisocial personality disorder (ASPD) are two different personality disorders.  They do, however, share some similar traits.  For example, failure to conform to social norms and lack of feelings of empathy or guilt are common characteristics.  While people with antisocial personality disorder are more likely to exhibit criminal behaviors or have a criminal history, people with narcissistic personality disorder are not necessarily prone to criminal activity.  Although people with narcissistic personality disorder may not commit criminal acts, the behaviors they exhibit may cause devasting effects, nonetheless.  Both people with antisocial personality disorder and narcissistic personality disorder exhibit self-centered behavior and have a flair for the dramatic, especially if it means making them the center of attention.  They both use manipulation and cunning to get their way. 

Sociopath DSM 5 Treatment

Although there is no specific cure for antisocial personality disorder, many mental health professionals are of the opinion that psychotherapy, or talk therapy, may be effective for some people with the disorder.  Psychotherapy focuses on helping a person learn to manage negative thoughts and behaviors and to build more effective communication and interpersonal skills that may be lacking.  Often, the first goal of treatment is to implement measures that may reduce the impulse to engage in harmful or risky behaviors.

Another type of therapy that may be helpful is called reward therapy.  Reward therapy involves giving the individual with antisocial personality disorder a reward when they engage in behaviors that are in line with social norms.  This type of therapy has shown to be effective with some people who are incarcerated.  Reward therapy works on the basis that people with sociopathic tendencies respond to the instant gratification of their wants, and this instant gratification makes certain behaviors beneficial to them. This system only works if the individual believes the behavior and reward are worthy of attention.

This reward system is like behavior modification therapy with one major difference. Behavior modification works on the idea that eventually, through the modification of behaviors, the individual will no longer engage in unwanted behavior. However, the reward system does not claim to modify behavior. It simply controls it for the time being.

At this time, no medication has been approved by the United States Food and Drug Administration to treat antisocial personality disorder.  Some medications, however, may be prescribed to help reduce impulsive or aggressive behaviors.  It is important for a mental health professional to evaluate the need for and monitor any medication regimen for effectiveness.

Unfortunately, it is important to note that, because many people with antisocial personality disorder do not feel there is anything wrong with them, they are often unlikely to seek help.

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BetterHelp Can Help You

Knowing there is no cure for the disorder and knowing that the treatments, which are available are not particularly helpful, can be disheartening. But nonetheless, therapy and counseling are still recommended for the individual with the diagnosis as well as their families and loved ones. It is not an easy task interacting with, living with, or being in a relationship with someone who is a sociopath. It can take an immense toll on the mental well-being of everyone.

Therefore, therapy is strongly recommended. If you are experiencing something like this or having a difficult time coping with a sociopath, consider seeking help for yourself. If seeing someone in person is not an option for you or if it makes you feel uncomfortable, you can still get plenty of help and support through online counseling. BetterHelp has a team of therapists who can answer your questions and give you the support and help you need in a trying time. Read below for some reviews of BetterHelp counselors.

Counselor Reviews

"Dr. Anstadt is helping me figure out how to live a quality life. His wisdom and knowledge are helping me navigate my negative thoughts and dig out where they are coming from, which is what I need. I can't recommend him enough."

"Kristen helps me to see my life and myself from a different perspective. I tell her about my experiences, and she is able to hone into another side of the story that I couldn't get working things out on my own. And I had tried for a very long time. As someone particularly skeptical of counseling in general, it has been refreshing to speak and work with someone who genuinely recognizes that I am seeking help but reluctant to take it. Her patience and consistent inquiry have been the greatest asset for me, and I appreciate my time with her."

Conclusion

While being labeled a sociopath implies negative connotations, it does not have to be a negative thing. Some of the most successful people in this world have been diagnosed with antisocial personality disorder. It's all a matter of deciding what kind of person you want to be in life and channeling your potentially negative symptoms into a positive outcome.

There is nothing wrong with being ambitious and confident in your abilities. If you are reading this article, you're already one step ahead of others because it means you care about how your actions affect those around you. If you are looking for some help on how to manage your symptoms or how to be a better person, get some professional guidance, lean on your support system and lead a life that makes everyone proud!

Frequently Asked Questions (FAQs)

Do sociopaths make you feel like you’re crazy?

Sociopaths are master manipulators.  They often employ manipulation tactics to gain emotional control over others and to cause doubt or trouble for others.  This behavior is an example of how a person with antisocial personality disorder believes that they are better than others. 

Can a sociopath be fixed?

There is no cure for antisocial personality disorder.  Because people with ASPD have an inflated sense of self-esteem and an extreme sense of entitlement, they typically see no need to change their own behavior.  While people with antisocial personality disorder do need help, they need professional help.  It is important to remember that your own safety and your physical and mental well-being are important.  Therefore, you should not try to “fix” a sociopath on your own.

Should I end a relationship with a sociopath?

While many people would say that ending a relationship with a sociopath would be the “simple” way out, it is understandable that this is not always a practical option.  If you are married to someone with antisocial personality disorder or are closely related to someone who has the disorder, seeking marriage or family counseling may help to develop a more stable relationship with the person.  For therapy to be effective, however, it’s important for you to understand that a person with antisocial personality disorder will not likely comprehend your emotional responses to their behavior and may show little regard for your thoughts or feelings.  Your safety and well-being should be a priority, no matter what decision you make.

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

Sociopath and psychopath are the terms frequently used to describe someone with antisocial personality disorder.  They exhibit some of the same characteristics.  However, there are also some behaviors that distinguish sociopaths from psychopaths.  Their behavior toward others and their actions in social settings are common distinguishing differences. 

For example, psychopaths are typically very organized, almost to the point of being obsessed with organization.  Sociopaths, on the other hand, are often very disorganized.  Psychopaths and sociopaths both lack what many consider “normal” human emotion.  Psychopaths do possess the ability to understand emotion and often learn to mimic the emotions of others.  This is one thing that makes psychopaths master manipulators.  Sociopaths are believed to have some sense of conscience.  However, they lack a desire to do right instead of wrong and typically do not try to hide the fact that their goal is self-gratification, no matter the cost.