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.
tryingtorecover
I haven’t posted a comment in a long time. I’ve been trying to just live my life. I’ve been doing well, but i found out yesterday my ex and the girlfriend moved to my small town. I haven’t had to worry about running into them because they were out of state at first, then 3 months ago they moved an hour away, and now 5 minutes away. My son came home yesterday from his visit with his dad and asked if I was sitting down. He told him he moved last week.(could be longer the last med. bill I sent was returned)
Everything is coming back. All the pain , just everything. My son recently called him on some lies he told him and then my ex called my cell 12 times in a row. I did not answer. It bothered me while my phone was ringing, but the next day I was ok. I’ve been getting stronger.
I keep asking myself, why? I know the answer-he’s a sociopath. His answer will be he wants to be by his son. (so far he saw him more when he lived out of state) But, why not live in the next town where they would be going to a different grocery store, a different movie store, a different everything. Why? I don’t know why it keeps going through my head. I know the answer. I have to stop writing. I haven’t felt like this in months.
I’m in the process of finding a lawyer to take him to court for enforcement issues so he’s going to be even more upset with me in the near future.
If anyone has suggestions how to handle running into them, please share them with me.
Beverly
Dear Tryingtorecover. Welcome back, I do remember you from some time back and glad to hear that things have been well for you. I live in a smallish town too and had the same problem, although we do not have a child together. At first I tried to regulate when I went into town, avoiding times when he might not be at work or just going to certain parts of town. In the end, i couldnt keep track of his working rota and I thought I cant pussy foot around him and give him that power. So I just go about my business as though he doesnt exist. I have seen him and was extremely near to him, but now I just ignore him and he ignores me and that is fine.
Problem is, when your son is visiting, he is sure to be a conduit for information either way. Presumably, if he has a girlfriend he will not be causing you emotional upheavel – so, is it the embarrassment of seeing him with his girlfriend?.
Lib
Gillian:
I guess what I meant when I said I don’t want to get rid of all emotional connection is that I don’t want to feel this way again, but I don’t want to forget how it feels. I too really look forward to the time when I am not wondering where he is and who he is with. I do want to be free of him and his negative energy.
hens
Gillian I hear ya loud and clear about the emotional connection and negative energy. Anything and everything that triggered a reaction in me, I got rid of, I even dug up the lillies he helped me plant. He collected wind chimes, they are now in the bottom of the lake. All I have left is his cat. I can’t throw her away, I love animal’s but I so wish I could find the cat a good home. Like you I will never forget him. And I look forward to not thinking about him or wondering if he will show up. I seriously doubt I will ever see him again. I am not bitter or angry, but just still a little crazy about the illusion thing. And I can say his memory is fading, ever so slowly.
Lib
Wow Henry, even the cat?
I am not near the point that I can throw anything into the lake. Well, he has never given me much to throw away. What I hold onto now is a list of his contacts from an old phone and email address.
hens
Lib.. Throw that phone in the lake. It has negative energy that is holding on to you. 🙂
Beverly
Hiya Dear Henry. How you doing? I got rid of nearly everything, even the pillows he put his head on. I have one photo left and a piece of electrical equipment. It also took a while for that ‘toxic feeling’ to leave my house.
hens
Hi Beverly I am doing good, thank you. I have heard of (Sharman’s) not sure if i spelled it right. But they come to your home and light ensence and walk through your house and cleanse it of bad karma and negative energy left by evil people. Have you ever heard of this? Good to see you Bev
Beverly
Yes, Henry, I do know about it, I did a course on it myself – I did a course on space clearing. Mainly his toxic essence was in my hall, but opening the windows clears the energy too.
tryingtorecover
Beverly, thanks for responding. The girlfriend is the same one he cheated with. The thought of seeing them together just brings back everything. I thought I had come through most of the pain , but here it is again. I guess I would already have dealt with it if I hadn’t moved home one month after he moved out. My son has also not re-met the gf and does not want to.( we both met her once when we ran into her in a parking lot and my ex pretended not to even remember her first name when he introduced us to her -I so bought the just friends thing) His dad has tried to trick him a couple of times into meeting her, so I think him moving into town is partially to force that issue. I don’t know anymore I just want to be done with it, but that’s not happening.