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.
You decide. Moving on.
Hi Kimmy!!!
🙂
I’m sending you the smiley brigade.
Damn…..I’m not here very often….funny how life changes, and sure as shit, somethings remain the same!
I just watered my garden tonight, and noticed my last daffodil has withered away. Daffodil season is officially over in my garden.
Onwards and upwards, we’ll see just what sprouts up next. Jr planted clover….ALL OVER as a mothers day gift to me…..it’s taken over as suspected. He had good intentions…..and has since realized that clover is more of a weed than anything.
Clover is a weed I can live with……cheatgrass…NAH!
I hope your well darlin.
As I hope all of my LF friends are moving along in the journey to healing.
Think of you all.
XXOO
EB
EB. How the hell are ya? So very glad to hear your voice!
Clover may be a weed but it’s a pretty weed. Jr. loves his mama.
Yes, I have been neglecting the land-scaping this year. I am working a lot and don’t seem to have the time I did last year….but I still have some plants and flowers that are thriving. I have some indoor stuff too, that I like to put out in the sun sometimes.
I miss your bear. Any new bears?
Eb, I’m doing really good. Got my feet back on the ground, taking care of me. You’d be proud of me….I am.
Thanks for reminding me about the flowers.
Hi Kim, Hi EB,
Nice to “see” you both.
Kim, I love how you always know the meaning of words!
EB, clover does take OVER! Lol!
Lenore, It’s almost impossible for ANY person to see past their own cog/dis, even spaths (ESPECIALLY SPATHS). You need to commit to admitting that you are not always right, you aren’t the best person in the world, and you do a lot of things wrong. Humility is the first step. If you really want to stop being a spath. It’s really really hard for anyone but it’s especially hard for someone who needs as much reassurance as a spath does. At first, you will find it impossible. Absolutely impossible, it’s that way for EVERYONE. Keep thinking about it, every once in a while. It takes time, eventually it might sink in, that pain is ok. Humility is ok. good luck.
This is an old post. I wasn’t around here when it came out originally.
Two thoughts –
I have no idea where Dr. Hare came up with that they mellow after age 40 came from. He based that on what?
My P sister attacked us when she was in her early 50s and my S mother was in her mid-80s. If anything, they had honed their skills and manipulations into an art as they age. They’ve been telling certain lies for so long that at this point, they probably even believe some of them are true or can’t separate fact from fiction.
Isn’t that what they say about career criminals? That sending them to prison is like sending them to Bad Guys U? Just like people have legitimate careers and gain skills as they move through them, so do the bad guys, except they’re learning things that are harmful to society.
The second thing about my P sister and S mother, all my life I remember both of them complaining that they “needed to do something.” They couldn’t simply sit still and relax.
It was compulsive almost. They had to be cleaning, cooking, fixing something. They couldn’t stay put. They’d be rubbing their hands and flexing their fingers. They didn’t look particularly comfortable when they were in that space.
They could be exhausting to watch.
Looking at Dr. Hare’s groups now, he either needs to add or modify something.
A lot of us have been attacked by Ps by perfectly legal means. Technically, their behavior is not criminal although morally, I certainly would call it as that. Speaking of which, where does poor morals or lack of morals fall in that chart?
They are not all parasitic. Some are extremely successful, either through legal means or deception. Is “parasitic” expanded on somewhere? You could call Wall Street parasitic, but seeing the other terms classified with it, this strikes me as describing people most would call “losers,” the ones always looking for handouts from somebody, a place to crash etc.
I can find a lot of laws that my P sister and S mother broke when attacking us, but they were never caught or charged with any crimes therefore, technically, theirs was not criminal behavior.
So, how would you classify people who bad mouth you to others? Ruin your reputation? (Yes, there are laws against this, but good luck finding a lawyer who would take such a case and you having enough money to pursue it in the first place.) Got plenty of lawyers who told me that I had an excellent case of malicious prosecution. Is it criminal because they were never charged with that?
What classification would emotional abuse fall under? How about neglect?
Dr. Hare’s groups don’t seem to take the full spectrum of a P’s behavior and abilities into consideration.
What does “criminal versatility” mean? They can commit more than one type of crime? (They look human, they breathe our air, and they walk our planet – All of which are criminal in my opinion.)
Where in those groups do “need to harm others,” “enjoy deceiving others,” and “target the trusting” fall?
Maybe what is needed is a third column? Column 1 is about SYMPTOMS. Column 2 – Lifestyle? Column 3 – that could be about their behaviors!
I might not have any remorse over not doing the dishes tonight or failing to brush my teeth this morning, but that hardly makes me a P. Does Hare’s scale get into what kind of remorse he means or is talking about?
Where do Ps actual behaviors fall? The things that create their symptoms and lifestyle? I don’t see any place for them in Hare’s grid.
I’ve heard that Hare has been concerned that his grid is being misapplied.
I can see one misapplication immediately. If we go to court and try to explain that the Ps are Ps, using their behavior, that behavior doesn’t show on the grid.
Dr. Leedom said that the courts are interested in the second column. The absence of the behavior should be given as well because you know what is going to happen, don’t you?
The lawyers and judges will look at the grid, tell us that what we’re describing isn’t there, and that we don’t know what we’re talking about.
Hi Skylar!
Kim, so glad to hear your doing well!
All is good on this end……life has continued to head in the right direction. And I have a date next week! Having fun!
I’ve found a better balance between social and work and I have the emotional energy these days to make time for just me!
my business is thriving and the money is rolling in, so I don’t have the financial burdens of days gone by.
Jr got a new EOP on spathdad about a month ago, so that will keep him at bay for another year…..and it seems as if he’s (like clockwork) starting to make major turmoil in his now ex fiances (gaga) life and her baby daddy ex. I believe she may be toxic too. two peas in a pod! 🙂
It does take time, but the farther away we get and the willingness to make the necessary changes in our own lives….AS YOU HAVE DONE….are all part of the journey back.
I remember the day……it felt like life would never return.
But….it does!
We’ve got to walk through the flames, do the work, learn in order to heal.
It’s hard, hard work……but the most rewarding thing i’ve ever done for myself.
I see a future now…..as I didn’t before, it was moment to moment.
I see a nice vacation in the fall……
I see fun events for summer…..
I see FREEDOM!
XXOO
EB
PS….no bears at my new house yet. I did see one coming home a few weeks back. Pulled over like a race car driver and scared the bejeebers out of him. I’ve got the blue jay babies that just left their nest yesterday….flopping around the yard. Holly thinks they are her personal toys….till I remind her differently. They are so dang cute! It’s a reminder……its’ summer!
G1S, perhaps Hare’s a sociopath, himself! You’re absolutely 100% spot-on that spaths don’t “mellow” with age. They simply evolve to use whatever suits their needs.
EB, great to “see” you and read that you’re in a healthy emotional space! Balance…awesome!
Keep in mind Hare based much of his criteria on criminals. Given this, I fully agree that the Hare Checklist is not a fully accurate criteria for many psychopaths/sociopaths.
This is why I argue for too separate categories, psychopath and sociopath, with the former being “classic” and accurate defined by the Hare Checklist and the latter, sociopaths being better defined only by Factor 1 traits.
On a side note regarding criminal behavior, our entire system, both psychiatric and criminal, is highly biased toward overt and obvious destructive behaviors. For example, White Collar crime goes largely unpunished, thus Hare would not have had much access to these “non-parastic” criminals.
However, one might now argue our Financial Services industry is completely parasitic.
Was Hare a sociopath? I am not sure about that. However, in Psychiatry and Academia, Narcissism is certainly rampant.
Why would anyone even think that Hare is a P? There is absolutely nothing to suggest that.
BBE,
While the confusion in calling the “condition” by any number of names, from sociopath and psychopath to ASPD, etc. because the professionals can’t agree on a name, much less a definition….the public is totally UNEDUCATED about the personality disorder.
Is Bernie Madoff any less a psychopath/sociopath/ASPD than my son Patrick who murdered a girl in cold blood? Me thinks not.
Is the stock broker who insider trades, or the politician who insider trades (which for congressmen until recently was LEGAL) any less a psychopath (et al) than Patrick? Again, me thinks NOT!
Whether the crime is scamming a woman out of her money, or her virginity or her love is maybe less of a “crime” in terms of what our society sees as “criminal” behavior, I think the same thing that makes a psychopath (et al) a love scammer, or a sexual scammer, or a love con, or a white collar criminal is the same thing that makes a psychopath (et al) like Patrick take a gun and shoot a girl in the head…lack of conscience.
So what is the difference if a person is robbing liquor stores, or cheating on the stock market, or cooking the company books? Not a damn thing in my opinion. It is PREYING ON SOMEONE ELSE. What way they prey on others is beside the point. It is predatory behavior.
I’m with Grace, though, I can’t figure out where you would get the idea that Hare is a psychopath? Or even a narcissist. I know several psychologists/psychiatrists who are both Ns and Ps, but I don’t think Hare is one of them.