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.
Gillian, Oxy and anyone else who posted about how difficult it is to lose an S/N/P (sorry I’m skimming before bedtime)…
This hits home big time!
I told the ex S in the midst of his D&D stage that it would be easier if “he were dead”. It was true. He held that against me for…well forever as he hold grudges and never lets anything go. He’s such a keeper! >thank God for sarcasmsniff snifffill in the blank with any expletive you like as they all apply to him
Hey my post got cut off and mangled…what happened?
I don’t know takingmeback, sometimes it does that to me too. Not often but sometimes, I just come back on and “write continued” and go on. LOL
I do believe physical death (as a loss) is easier on the survivor than it is on the victim of a LIVING PSYCHOPATH. At least in the case of my P-son it sure was. I admit after I found out that he killed that girl, that I wished him dead, and her alive and in prison, it would have been easier on me!
Now, as far as my son is concerned, he IS DEAD to me. It was hard and long getting to that point but I am comfortable with it, just as I am accepting and comfortable with the fac that my husband is dead and isn’t coming back physically. It isn’t what I wanted, but it is what IS.
I’m getting to the point (slowly, and not there yet) that I can also adjust to the fact that my mother is out of my life too. I no longer am responsible for her either.
Adjusting to all these losses of what we thought were “loving” relationships is difficult, but it is the only thing that CAN SET US FREE of the chains of “emotional slavery” to a fantasy.
Ah, it keeps doing it.
My heart goes out to you Oxy. You are in my prayers as you grieve your mother’s absence in your life. You are so strong and inspirtational. I am paying attention to what you write and I am going to work on the fact that the ex S is truly dead to me and imagine that he doesn’t exist anymore.
Thank you as always.
I even had a little “ceremony” for the “burial” of my P-son, sort of like you might have a private memorial service for someone whose body wasn’t recovered. It sounds sort of silly maybe, but the emotional part of it was actually comforting to me.
I have talked to others who would go have a ceremony with throwing their wedding rings into the ocean or a lake or burying them or whatever, just something to symbolize the “death” of the relationship.
Since I am totally NC with mother now (I tried limited contact, for business only) but now I am even handling that by proxy as even seeing her now sets me back emotionally. NO contact is best at least for a LONG TIME if not forever. I know her health is precarious and she is likely to have a fatal or debilitating stroke any time (she is 79 and has already had several strokes but none terrible up to now) and I know she is under a lot of stress, lonely etc. which won’thelp her mental or physical health either) and I am more or less preparing myself for her declining health or even her death in such a way I am not going to feel “guilt ridden” that I “neglected” her in her old age, etc.
Actually she rescinded my power of attorney and it dawned on me that I do not have the authority to take care of her needs, therefore I do not have the responsibility either. My first cousin is her POA now, so he has both the authority and the responsibility since he took it on. She isn’t pushing a shhoping cart on some street, she is comfortably in her own home with some paid care giving and a paid driver, so she is not in need. I just no longer supervise her medical care, take her to the doctor etc. or socialize with her at all. What business we have to transact for the family land trust I communicate with her via my sons who do talk to her on a limited basis, but don’t trust her at all. I no longer FEEL responsible since I realized I am not leagally ABLE to do for her (I am her only child) so it is the “final hurdle” since I seem (at least today) to be okay with the X-BF-P, the XDIL-P (I never liked her anyway) , the TrojanHOrse P and my P-son.
My relationship with the son C married to the DIL-P and my relationship has been restored with her out of the picture, which is WONDERFUL. He currently lives out of state but we are closer than ever and talk constantly on the phone. I think he will be coming home before long, he’s pretty home sick I think. He and my adopted son D and I are all on the SAME page again and that is just the most wonderful gift from God that I could have had. Both young men have learned a great deal of good lessons from this as well, and I am pleased that even though this was quite painful, there have bene some great side benefits from it as well.
I am sure too, Takingmeback, that in your position as a therapist you will do A WORLD OF GOOD for the families of thes e people, and though you can’t treat the Ps, you can help their families survive and get through it. I bet a dollar that you have people who come to you for therapy because they are in a relationship with a P or have a P family member. Think of the good that you can do for those people, and turn this horrible event into MEANINGFUL learning. Not only beneficial for you, but for those clients that need it.
Look how much good Donna’s P-experience has done for others, for you and for me and so many hundreds of others here on this site now and in the past and in the future! It ripples out like the waves from a stone thrown into a lake. We may not “cure the world” but if we help one person at a time, and that person helps another, it spreads out in unending waves of goodness. Look how many people Viktor Frankl has helped, and he might not have been so wise and helpful if he had not had the horrible experiences he did. His book has helped me a great deal and I know you said you loved his book too. Go back and read it again and again. I am rereading it in part every night before I go to sleep. It gives me comfort to read his words. (((hugs))))
Oxy,
I was thinking of a ceremony to do as well. Your previous post inspired me. I have gotten rid of everything he gave me and any reminders of him. I have even changed my house so it’s different from when we were together. I needed a total transformation. I am going on vacation soon to the ocean so perhaps I can make something I can cast out to sea. Oh I just remembered I have a “message in a bottle kit” I bought last year. I still have pictures on an old computer. Maybe I can print them out, erase them off my hard drive, and burn them. I can put the ashes in the bottle and send it adrift. Now is that legal or would it be considered littering? LOL. Perhaps I should put a warning on the bottle, “Beware, remnants of sociopath inside” LOL.
I have also wanted for months to have friends over for a get-to-gether. I have these great paint markers that are actually water-based and washable and I want all my friends to write their most favorite, encouraging quotes or personal anecdotes on the wall in my home office. I want something to sit and ponder during my difficult times. To remember I have friends who love me. They may not understand all I’ve been going through but just knowing they’re there is helpful.
It’s been a productive night for me :). I do hope that the families and victims of Ps that I work with do benefit from my experience. I do feel more qualified in really knowing now what is most helpful in their recovery and how to truly provide good psychoeducation about the disorders. I have had some clients already say that they can’t believe I get it as so many other therapists haven’t. That breaks my heart but I’m glad I can be there for them. Just that validation for them alone does wonders.
I hope we all send ripples of truth out there for people to get educated. It’s not easy but someday I hope it becomes more public and people start to get it. We’re planting seeds regardless.
Blessings 🙂
I had a “ceremony” about two month’s after he left, I got rid of everything he left here or reminded me of him, but I wanted to keep his wind chim’s that hung here and there. To me they represented the good thing’s in this person, what little good he had. But their chims in the wind were never comforting. So I took them all down and drove to the lake, one by one I threw them into the water where they sank to their silence. With each toss I greived and sobbed like never before. I was saying good bye to Mike – that was when I finally accepted who he is. Thats was when I knew I had no choice but to go on with out him. That was a day i will never forget..
Oh Henry – what a sad story. I really feel for you and you obviously thought alot of him at the time. For me, its not just about getting rid of the possessions, although that is very therapeutic, it is also about getting rid of him out of my head.
Dear Takingmeback, that is such a good feeling to know that you can use your painful experience to help the pain of others. BEing able to use your own painful experiences to help others is a good feeling for YOU as well. Helping (not enabling) others and passing on the blessings that you have received is a wonderful feeling. As Jesus said “it is more blessed to give than to receive” and when we HAVE received, to be able to pass that blessing on to others does not diminish our own blessing by one bit. “A sorrow shared is halved,and a joy shared is doubled.”
What a wonderful idea too about having your friends write on your wall!
Henry and Bev, getting them out of your head as far as “forgeting” that they were ever there I think is difficult to impossible, but for me, getting the PAIN ASSOCIATED WITH their memory to leave is the goal.
To be able to remember but not flinch, to just accept that they were and they are no longer, and not feel the grabbing in the pit of my stomach or the choking in my throat, the physical manifestations of the emotions involved. To resolve and let go of the anger and the rage and the wish for revenge which was there at first. I’m getting there, but do admit I have some set backs and some days not as good as others, but over all the progress is positive and for that I am thankful.
What I find now is that I don’t have a “reserve strength” to deal with the little emotional dramas that come up with other people, not Ps, but just “jerks”—I let those things irritate me more than I normally think I would. That tells me that I have some issues to still work on, and so I am working on those issues, so that I can have the “reserves” of emotional strength to use for just “normal irritations of life.”
Things like flat tires, or delays in traffic etc don’t rub me the wrong way, or even some jerk cutting me off in traffic or giving me the finger don’t bother me, but when people I know are disrespectful, inconsiderate, or just out and out rude, it does irritate me more than I think I should let it if I was “whole”—and instead of lashing out at them, I tend to “implode” and cry.
Having more energy to do things though I think is a good sign for me, and feeling better about myself, wanting to accomplish things. Now if the darned heat would abate a bit or it would rain a little, I’d be “totally happy” LOL Ah, the joys of a Southern summer–heat and humdity! But this too shall pass. LOL
part of me enjoys the idea of an sociopath having a medication induced mania and thus letting down their guard and charm enough that people can see who they really are. they may be acting out just as much or more, but at least it’s obvious and people can take cues to sidestep such a character.
my experiences with s-paths are actually ‘friends’ and not ex-s like most of you. my old supposed best friend is considered a ‘covetous sociopath’ and is a manipulative, charming, evil bitch. every man would kill to get their hands on something that oozes that much personality and sex appeal and if they do, she pushes the boundaries of mindfucking. i’ve known multiple ex’s of hers that she’s toyed with so much they fall into crushing depressions, even attempted suicide, all for her amusement. she ruined my adolesence by first bringing me on as her ugly sidekick to make herself look better and when i outgrew my awkward stage and actually became competition, she came after my self esteem with a vengeance…taking my lovers, spreading rumors about me or personal secrets, intimidating me with verbal abuse…all the while staring at me innocently “why would you think that? i’d never do anything to hurt you”
the thing is though i FINALLY ditched her ass when she stole 1,500 dollars from my mom, tried to sleep with ANOTHER one of my guys and wrecked mental havoc on me when i gained weight…every now and again i check up on her through facebook and the thing is, she’s on a wonderful downward spiral. addicted to drugs, pregnant, thousands of dollars in debt, no life plans, etc. nobody from my town will associate with her after the last time she was there…she was manic from blowing so much cocaine. she would never take medication, let alone go to a psychiatrist, but her drug use blew away any facade she had and every one could finally see she wasn’t so sweet and funny and cute anymore, she was a monster. now when i come back from college (god its so nice to know i have my shit together and she doesn’t…) i don’t have to run the risk of seeing her in my home town because she doesn’t bother coming back…nobody will talk to her, thus, no one to use. for once, thank god for cocaine.