It turns out that Sandy Brown, M.A. is quite correct in stating that any talk of treatment of sociopathy makes people (particularly women) reluctant to give up on a dangerous relationship. We received a note this week from a woman asking for more info about treatment and wanting to know if there was any hope for her man. He was the only man she had ever loved and she was actually still grappling with the meaning of his diagnosis.
This week, I will discuss medications that can be used to treat sociopathy. But before I do I want to make it clear that I encourage people to break away from sociopaths. Remember that the sociopath’s doctor and therapist will want you to stay with the sociopath to assist in the treatment. Sociopaths “do better” with treatment and when they stay married. So let me explain what “do better” means. Also this discussion will help you if you are still grappling with the meaning of your sociopath’s diagnosis.
One of the ways to assess sociopathy is with the Psychopathy Check List-Revised, developed by Dr. Robert Hare (PCL-R). The PCL-R is a 20 item psychological evaluation that professionals with training complete on a person using an interview and a review of criminal/ psychiatric records. When someone scores above 30 on the PCL-R that person is “a psychopath.” Most people who psychiatrists would consider “sociopaths” score above 20 on the PCL-R.
Researchers have used the PCL-R to evaluate large numbers of people. They have found that some items of the 20 item test are correlated with each other. That means that say a person who scores high on item 1 is also likely to score high on items 2, 4, 5, but not necessarily item 20. On the basis of these item correlations, researchers have grouped the items into two “factors” each having two “facets.” I will use these factors and facets to discuss with you what aspects may respond to medication. Two items of the PCL-R do not belong to either Factor 1 or 2. These are Item 11, Sexual Promiscuity and Item 17, Many short term marital relationships. These items stay part of the PCL-R because they are so integral to psychopathy as you already know!
Factor 1 Interpersonal/Affective |
Factor 2 Lifestyle/Criminality |
Facet 1 Interpersonal Symptoms | Facet 3 Lifestyle |
1. Glibness/superficial charm
2. Grandiose sense of self worth 4. Pathological Lying 5. Conning/manipulative |
3. Need for Stimulation
9. Parasitic Lifestyle 13. Lack of realistic long term goals 14. Impulsivity 15. Irresponsible Behavior |
Facet 2 Affective (emotional) symptoms | Facet 4 Criminal Behavior |
6. Lack of Remorse/Guilt
7. Shallow Affect 8. Callous/Lack of Empathy 16. Failure to accept responsibility for actions |
10. Poor behavior controls
12. Early Behavior Problems 18. Juvenile Delinquency 19. Revocation of conditional release 20. Criminal versatility |
Look at the Table above and consider that you are interested in the two items that are not part of either factor and Factor 1. These are the symptoms that are most concerning to family members. The criminal justice system and professionals are most interested in Factor 2.
Look at the list again and imagine a person with a great deal of energy either because he or she is manic or because he or she is on speed. In that case Items 1, 2, 5, 3, 13, 14, 15, 10, 19, 20 and 11 would be most affected. In fact this is why there is overlap between bipolar disorder and psychopathy.
Anything that increases a sociopath’s energy level makes him or her worse. Anything that reduces his or her drive leads to “improvement.” That is why, medications for mania like lithium, anticonvulsants and antipsychotic drugs have been used “successfully” to treat sociopathy. In this case success is defined in terms of fewer arrests and aggressive acts.
Also look at the list and notice that Items 3, 14 , 15, 10, 19 and 11 are related to poor impulse control. These symptoms may respond to antidepressants that work on the serotonin system. Defects in the serotonin system are thought to underlie impulsivity. The problem is that many people become manic when they take antidepressants so these can also make a sociopath worse.
Okay, now see what was left off the list, and you will conclude with me that medication will not turn your sociopath into someone you want to spend your life with. Many people say that the sociopath’s energy and spontaneity are what they find attractive. If that is the case for you, then medication which reduces a sociopath’s energy level will make him or her less attractive to you. All the “fun” part of the sociopath may disappear, leaving you with a boring parasite.
Nothing will make a sociopath loving and empathetic or build a conscience. A loving person takes care of his/her family, is trustworthy and doesn’t lie. Medication cannot make a person loving; it can only reduce dangerousness. Focus on the use of the term reduce, as I did not say eliminate dangerousness. In a hypothetical research study, a 50% reduction in the battering of family members and a 50% reduction in arrests would be considered “improvement.” That does not mean sociopaths are turned into people you want to share your life with.
So why do I even discuss treatment? Only to keep you informed and for those who for whatever reason choose to share life with a sociopath.
Next week psychotherapy for sociopathy.
Oh lenore, my heart goes out to you.
From my understanding, it is the left pre-frontal lobe that is numbed from shame experiences. It’s just like being an alcoholic, except you create your own endorphins.
I wonder if electroshock therapy would work? It’s worth a try.
Skylar,
I was also wondering if perhaps there are different types of sociopathy? I am reading these comments, and I am quite confused, to say the least.
I have been tested, and the psychologist was quite adamant in her diagnosis, but I don’t recall doing such horrible things to people intentionally. I mean, legally I am quite guilty to their harsh comments, but I try not to harm those I’m involved with.
Lamorte,
yes, there are different “presentations” of sociopathy.
My ex-spath was a PURE psychopath. He didn’t even have a startle effect. He felt nothing, but he FAKED everything. He would never admit to his psychopathy. When I called him a sociopath, he said, “don’t call me a social spaz, I’m not a social spaz”. LOL. it’s true, he’s not a social spaz, but he is a psychopath.
I know another spath who has EVERY cluster B PD plus some extras. Some of them, like OCPD, cancel out some of the other PD’s. For example, OCPD’s will blurt out the truth. While psychopaths will lie every time their lips move. It’s fascinating to watch.
You might consider having another evalution. If you have more than one PD, it can be confusing to the therapist.
You say that you don’t have the intent to harm, yet you MUST know that you will because, as you admitted, you warn the women before you do it. So which is it?
Hens,
You can talk to me about potted plants, I’m also a fan of gardening. 🙂
Skylar,
I have no INTENT to harm, but it always happens. Whether it’s white lies that build up or a lack of a suitable emotional response, it depends. I make no attempt to hide my disorder. I do not always see eye to eye with my psychologist, but I understand he seems to have my best interests at heart.
And I have been evaluated twice, once at 15, and another at 19.
And why is everyone treating sociopathy and psychopathy as the same thing? I was informed that sociopathy is a lack of true understanding as to what is “right” and “wrong”, while psychopathy is the blatant disregard.
well Lenore, You’re lucky that your shrink “seems” to have YOUR best interest at heart. Good deal. That’s why we try to avoid folks like you; because the only best interests you have at heart is your own. It’s a shame that people get hurt, when you’re just doin’ what ya do, but gosh, shit happens. Any advice? Ahhhh, no. Except that maybe you should talk to the folks at sociopathworld. they might be a better match for you. We don’t get it and never will. And OMG, am I ever grateful for that.
Lenore, I don’t speak French, but I did take a few classes in high-school and I also read a lot. Does your screen name translate to, “the dark, the dead?”
Kim,
You see, I am trying to understand what is acceptable or not! That is the entire reason for this! I am trying to avoid hurting those who actually accept me.
And Lenore is my url name, while I use Lamorte to protect my identity. Lamorte does mean “the dead” in french, but Lenore is actually a nickname of sorts for Eleanor which is “light”.
Ok. Kind of like the name “Lucifer”, which comes from the same root as “Lucid”, which means, shining and clear…gotcha. Thanks, Lenore.
Kim,
Ah, I’m afraid I’m confused. Was that an insult or a statement of fact?