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.
Henry.. you always crack me up. I’ll never be able to go to the lake again without wondering what’s at the bottom of it. It’s a good thing you are gay, or I think we would all be fighting over you.
Dear Tryingtorecover,
You are doing a great job with your son, and the therapy will help him get the idea what is going on. My X husband was mentally ill and my divorce pretty “crazy” and I took my kids to therapy for two years afterwards, but they were smaller than yours is now. The therpay didn’t do my P-son any good, but at the time I thought it was doing good as I didn’t have any problem out of him except once (which in RETROSPECT I can see actually was a P-incident) at age 11, but by puberty he was “full blown” P which I “passed off” as a little worse than ususal teenaged years, hoping it would resolve, but it only got worse. By 17 I should have cut the strings then and DUMPED him outright, but I didn’t. I think if your son is that “smart” and seeing things at that age (15) you have dodged the bullet where genetics are concerned. Plus, with him seeing the “light” about his dad’s lying etc. he is just going to be super and do so well! I know it is difficult for a kid to either have a “defective” parent or a “missing” parent.
I was fortunate to have a wonderful step father, but I still wondered about my abscent biological father. I was curious and wanted to know about him, to know him. I wasn’t prepared in any way for what I encountered when I went to live with and work for him. In retrospect, I was a “babe in the woods” for his manipulation and abuse. In the healing afterwards I was also “not informed” and stubling in the dark about what “train” had run over me….and all the things that we encounter now with others not understanding why we are so devestated, was SO TRUE. I tried to tell people and NO ONE believed me—since my second husband Knew my Bio father HE BELIEVED ME for sure. There are others who knew him who also believed me, but it was hard when I was so young and so naive.
So I’ve been on both sides of “that cloud now” and seen it from the child with the abscent parent-P who comes around when you are a teenager, and also the parent of a P who “blossomed” into a “full blown criminal P” by age 17, totally definant and out of control. He is so much like my P-bio father (whom he has never met) that it is SPOOKY. My older son C looks almost identical to my P-bio father (I also physically resemble my P-bio father much more than my mother’s side of the family) but my son C is NOTHING like my P-bio father psychologically or emotionally.
Yea, they spread their genes far and wide and generally don’t stay around to raise the kids, especially the males, but many times also they hang in enough to use the children as weapons to beat the mother over the head with. I feel for mothers who have children by these predators and I sure feel for the chldren who are either abused by visits, or made to “wonder” why no visits. Either way is sure not “ideal.” But of the two, I would prefer an “abscent” P-father for the child’s sake.
Good luck Kat with your children and you too Tryingtorecover. It sounds like you are both doing good jobs and that is all we can hope to do. Being a mother is the best job and the worst job in the world, but at the same time I wouldn’t have it any other way. Losing one child was painful, but the two I have left are the joy of my life!
i know this sounds silly,but i cant find an email address to the o magazine or show….the contact us doesnt work….anybody out there can help??….
What is the ‘o’ magazine? Are you talking about Oprah?
Psychiatr Clin North Am. 2006 Sep;29(3):709-24. Psychopathy: a clinical and forensic overview
.Hare RD.
Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia V6T 1Z4, Canada. rhare@interchange.ubc.ca
There is a substantial amount of empirical evidence that psychopathy, as measured by the PCL-R and its derivatives, is a predictor of recidivism and violence in prison, forensic psychiatric, and civil psychiatric populations. The PCL-R is one of the most generalizable of the risk factors identified thus far, and for this reason it is included in various actuarial and structured clinical risk assessment procedures. Although psychopathy is not the only risk factor for recidivism and violence, it is too important to ignore, particularly with respect to violence. Treatment and management are difficult, time-consuming, and expensive, but new initiatives based on current theory and research on psychopathy and the most effective correctional philosophies may help to reduce the harm done by psychopaths.
PMID: 16904507 [PubMed – indexed for MEDLINE]
I am trying to put these new therapies in perspective. An dit is important to note if you review the lit, a lot o fit is focused on children, not full-blown psychopaths.
yes beverly oprah thks so much for any help…its not very easy the contact us does not work for me
Dear NWView. I dont know much about Oprah or the magazine, I dont know if anyone else here can help you.
Try Oprah.com, it’s a general link to most of her stuff.
tks guys …i tried that, but no luck…im trying to do something for our community here….so maybe will need to resort to snail mail