Understanding Sociopathy: Living With Someone Who Has Antisocial Personality Disorder

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What is a personality disorder?

The most recent edition of the Diagnostic and Statistical Manual defines personality disorders as mental health conditions that involve rigid, unchanging thoughts, potentially problematic behaviors, and emotional patterns that deviate from social norms and cultural expectations. Several factors influence your personality, including personal experiences, genetic characteristics, and environmental concerns like socioeconomic status and surroundings. Personality disorders often present during adolescence or early adulthood. 

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5), there are several personality disorders organized into categories of clusters A, B, and C, including the following: 

• Paranoid personality disorder 
• Schizoid personality disorder
• Schizotypal personality disorder
• Borderline personality disorder (BPD) 
• Narcissistic personality disorder (NPD)
• Antisocial personality disorder (ASPD)
• Histrionic personality disorder (HPD) 
• Avoidant personality disorder
• Dependent personality disorder
• Obsessive-compulsive personality disorder 

What are narcissism and sociopathy?

Narcissism refers to self-serving behaviors without considering other people’s feelings. Sociopathy is an outdated term for antisocial behaviors, criminality, and a lack of regard for the emotions of others. Although similar, they are different labels. These terms are often associated with two personality disorders: narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD). 

Narcissistic personality disorder (NPD)

Some people experience a mental health condition called narcissistic personality disorder, which involves an inflated sense of self-importance, a constant craving for admiration and attention, and a disregard for or inability to understand other people’s feelings. However, behind the façade of confidence, people with NPD may become upset with criticism and feel insecure about their self-worth. 

Antisocial personality disorder (ASPD)

People with antisocial personality disorder show a consistent indifference to the boundaries of right and wrong, often ignoring the needs, feelings, or rights of others in pursuit of their own goals or pleasure. They may intentionally anger or upset others, enjoy manipulation, and lack remorse or regret over their actions. Some people with ASPD may act in criminal ways or disregard the law, believing they are above it. 

A look into NPD and ASPD 

Narcissism and sociopathy may look different for each person. While the following characteristics may help you recognize sociopathic or narcissistic tendencies in yourself or others, a doctor's diagnosis is required to know whether you may have ASPD or NPD. 

Antisocial personality disorder 

People experiencing sociopathic tendencies may show little concern for the conventional sense of right and wrong, operating instead on a self-serving philosophy that caters to their desires over the comfort, wishes, rights, or consent of others. People with ASPD often experience legal trouble because they disregard the boundaries of the law and may engage in risky, dangerous, violent, or impulsive behavior. 

ASPD often develops comorbid to conduct disorder, which involves severe, ongoing problematic behaviors in childhood, including but not limited to physical aggression or violence toward people and animals, destruction of property, dishonesty, theft, and persistent, serious violations of rules at home, school, and in the community.  

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Symptoms of ASPD include the following: 

• Ignoring societal norms 
• Creating one's own moral code and disregarding others
• Lying to manipulate and take advantage of others
• Being insensitive or disrespectful to others' feelings or ideas
• Using charm or wit to control people for personal pleasure or one's own gain
• Believing one is superior to others
• Being opinionated and disregarding the value of others' thoughts
• Experiencing personal and legal troubles due to pervasive patterns of inappropriate behavior
• Showcasing hostility by getting into physical altercations or having a threatening demeanor
• Lacking guilt about harming others
• Showcasing irresponsibility, including failing to meet work commitments or financial obligations
• Showing risky behavior with no regard for personal safety or the well-being of others

Narcissistic personality disorder 

The word "narcissism" traces back to the ancient Greek god Narcissus, who thought so much of himself that he lost the ability to see value in or love others. While "narcissist" is often thrown around without proper context, it refers to traits of self-interest at the expense of others. 

People with NPD often struggle with relationships, school, work, or financial stability. They may feel unsatisfied if not receive attention and praise from others and may feel unfulfilled or bored in work or personal relationships. 

The symptoms of NPD included the following: 

• A higher-than-average view of self-importance
• A sense that one needs excessive admiration
• A belief that one deserves special treatment, favors, and privileges
• An expectation of recognition without achievements to earn praise
• Exaggeration of talents and accomplishments to seem more impressive
• Preoccupation with fantasies about future success or being power hungry
• A belief that they are special and superior and that only other extraordinary people can understand them 
• Critical and condescending behavior toward people they view as inferior
• Expectations for people to cater to their wants and needs without question
• No concerns about taking advantage of someone to get what they want
• An unwillingness or difficulty understanding and holding space for others' feelings and needs
• Envy of others and a belief that others are envious of them 
• Arrogance, bragging, or conceited behavior
• Insistence on having the best of everything
• Materialism 
• Difficulty accepting criticism 
• Impatience when not receiving special treatment

The main differences between ASPD and NPD

Though APD and NPD show some similarities, critical differences exist in the motivations of actions, thought processes, and emotions that people with each condition experience and display. 

The motives behind one’s behaviors

One of the most significant differences between NPD and ASPD is the reasons behind abnormal behaviors. For example, the motives behind manipulation or unhealthy behavior may be different. If someone's motives are personal gain or a boost of ego, they may have narcissistic tendencies. If they manipulate others for personal enjoyment or because they are bored, they might be showcasing sociopathic tendencies. NPD and ASPD also commonly co-occur with each other, in which case someone may say they have dual sociopathic-narcissistic tendencies. 

Intention to cause harm 

People with ASPD may be more calculating, often intentionally causing harm to others or enjoying inflicting pain or distress on others while feeling no guilt or remorse for their actions. Someone with NPD may harm others but do so in pursuit of their goals or status.  

Risky and impulsive behaviors 

People with ASPD often engage in risky and impulsive behaviors that may be illegal. People with NPD may not take risks or partake in illegal behaviors. To appear likable to others initially, they may follow social rules to an extent.  

Legal and employment troubles

While ASPD and NPD symptoms and personality traits can make it difficult for people with either condition to maintain steady employment, people with ASPD may encounter difficulty with law enforcement because they show little or no regard for law and order. 

Presentation 

People with NPD or so-called “narcissistic sociopaths,” set great importance on how others see them and actively work to cultivate an appearance and reputation for success. In contrast, people with ASPD may not care what others think of them in any capacity and often show open disdain for the opinions of others. 

Narcissistic tendencies that are different from sociopathy include the following: 

• Concerns with others' view of them
• Selfish tendencies
• Constantly seek love to improve self-esteem
• Focus on the appearance of success
• Manipulation of others to feed one's ego
• Temporary or occasional sympathy and remorse 
• A low self-esteem 

"Sociopathic" tendencies can include the following: 

• A lack of regard for the opinions of others
• Antisocial tendencies
• Problem behaviors 
• Seeking or enjoying the misfortune or negative energy of others
• Manipulation of others for one's own pleasure 
• Lack empathy or remorse
• High self-esteem or self-perception 

Can ASPD and NPD be treated? 

As with other mental disorders, psychotherapy is the primary treatment method for NPD and ASPD. Talk therapy teaches clients to examine their thought and behavior patterns to eliminate negative habits and reinforce practical, positive coping and communication skills. 

Therapy is often one of the most effective elements of someone’s mental health journey. Your doctor or psychiatrist can decide whether medication is appropriate for your symptoms and circumstances. While no medicines are specifically used to treat either mental health disorder, both often occur alongside other psychiatric issues, such as depression or anxiety. However, effective treatment of either illness can require the client to recognize the problem and commit to making meaningful life changes. 

Support options 

In some cases, attending in-person therapy may be a barrier for people living with a personality disorder. They may not seek treatment with a therapist in an office due to financial insecurity, embarrassment, or another challenge.

In these cases, you might benefit from working with a therapist online through a virtual therapy platform like BetterHelp. Teletherapy is often less expensive, has shorter wait times, and offers flexible appointment formats, making it easier to work treatment into your busy schedule. 

According to the results of a 2020 study, online therapy can be an effective treatment option for people with personality disorders. Others said the convenience of attending therapy from home made it possible to participate more reliably.