Revised by Theresia Bedard and the North American Research Committee
Psychopathy and Narcissistic Personality Disorder are psychiatric disorders with slightly overlapping symptoms. Sociopathy, however, is an older, outdated term for what is now called psychopathy.
Unfortunately, the differentiation of these widely-used terms has caused much confusion among the general public and mental health professionals alike. Part of the problem lies not in differentiating among individuals or disorders but in differentiating between labeling or classification systems. Narcissistic Personality Disorder is included in the Diagnostic and Statistical Manual of Mental Disorders (or DSM, first introduced in 1952 by the American Psychiatric Association, and currently in its fifth revised version, called the DSM 5-TR). The DSM is a classification system used in the United States and several other countries to diagnose mental health disorders.
According to the DSM 5-TR, Narcissistic Personality Disorder is characterized by a pattern of grandiose fantasies and behaviors, a need to be admired, and lack of empathy which begins early in life and persists throughout the lifespan in multiple areas of functioning. A person with this disorder may also have a strong sense of entitlement, may frequently take advantage of others, and may often be envious of others or believe that others are envious of him or her.
Psychopathy and sociopathy are not acknowledged as disorders in the current DSM, despite the fact that psychopathy has been rigorously explored, defined, tested, and validated by researchers over the past several decades.
Both psychopathy and sociopathy are labels that have been historically used to describe psychopathy. Psychopathy, the disorder, has gone by many names. In 1801, psychopathy was called manie sans délire (“insanity without delirium”) by French physician and psychiatrist Philippe Pinel. In 1835, it was re-named moral insanity by British psychiatrist J. C. Prichard. In 1891, German psychiatrist J. L. Koch coined the term psychopathic inferiority (Koch chose the term “psychopathic”, which was actually a generic term for personality disorders until recent decades, to signify his belief that a physical basis existed for this condition—the term “inferiority” meant only that it represented an unfavorable deviation from the norm).
In 1952, the first edition of the DSM used the term sociopathic personality disturbance. This was the first official emergence of the term “sociopathy” to describe this condition, although this diagnosis was focused on internal psychological processes and personality traits (such as lacking remorse as opposed to more easily identified behaviors like committing crimes). Clinicians became concerned that the focus on internal processes might be the reason it was difficult for clinicians to diagnose personality disorders reliably. To address this problem, in 1980 the DSM-III introduced a more limited, behaviorally-based diagnosis called Antisocial Personality Disorder which arguably lost many of the key personality-based symptoms of psychopathy that had been found in earlier versions of the diagnosis. That is, the category of Antisocial Personality Disorder focused more on observable behaviours such as committing crimes, breaking rules, and lashing out at others. As such, Antisocial Personality Disorder and psychopathy are often confused, though they are not the same condition.
One prominent researcher (David Lykken) years ago suggested that sociopathy and psychopathy reflected two distinct pathological syndromes. He proposed that you could differentiate sociopathy and psychopathy based on causal factors (psychopathy was caused primarily by biological factors, and sociopathy primarily reflected social factors such as improper or ineffective parenting). There has been a lack of research that addresses this theoretical speculation. In fact, there is currently no validated measure of sociopathy which would permit researchers to study whether it has different causes or properties than psychopathy. Also, research about sociopathy or sociopathic traits has used measures that assess psychopathy, which means there is no basis for identifying any difference between psychopathy and sociopathy (since both sets of studies are using measures that assess psychopathy). Thus, the current confusion between sociopathy and psychopathy may stem from an unwillingness of mental health professionals to discard an outdated term, in spite of the extensive body of research developed on psychopathy but not sociopathy.
