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.
Well razzaradda: One down, how many more to go?
Your post made me laugh and cry at the same time. Yes, they unfortunately play with everyone, skimming the surface of life, never feeling anything for anyone but do what they think is good for them. Sad but true.
Even though she caused chaos in your life and stole boyfriends and money from your mom and did all her games surrounding your life and out of range of your life… pray for her to find her way back to God.
Peace.
Peace.
Dr. Leedom, I think this is an excellent article. I am hoping, however, you can expand on the topic of WHY the therapist would want a person to stay with the sociopath and assist in treatment. I understand being married or in a relationship may make the socio more stable, but it seems to me that IF the therapist knows the patient is a sociopath, it would be unethical to encourage a “victim” to remain and sacrifice themselves in order to help the sociopath. As your article has made clear, although some of them may improve a bit with medication, they are still going to be a sociopath at the core, thus the potential for harm. I can understand a therapist who is the therapist to just the sociopath would not step in and encourage a victim to leave who was not already trying to leave the relationship, since it is the sociopath they are treating, but I don’t understand them wanting or encouraging the victim to stay either.
All depends on how deeply entrenched they are in their behavior.. while a true S/P won’t and can’t change.. there are milder forms and people who are acting that way temporarily for other reasons, if they really choose to change, they may have the inner resources to do it. Plus sometimes the victims are just not willing to give up hope right away and will “fire” the therapist for suggesting they move out.
To everybody
what would it take….for you to accept them back into your life?
I’m asking this to try and anticipate my own blind spot, to try and prepare for any such eventuality….is there anyone here that is living happy ever after with reformed sociopath…even in cancer people can have “spontaneous remissions” and miracle cures….anyone out there with a book about a cured psychopath…?
It just occurred to me….lookat the quality of person on this site…have you noticed? very articulate, intelligent….caring, balanced….is this a result of having to survive a S or is it the quality that predisposes us to attracting them?
Staying sane & Dr. Leedom,
Wow! I had never read this particular article in all my time reading archived posts. It is an awesome article, Dr. Leedom… again one of those articles I think should be considered a LF “classic” and must read. Thank you, Staying sane, for bringing it back up for commentary.
Interestingly, it is especially timely for me to read this as my therapist has talked with me about another client who is in a very dangerous relationship with a sociopath and the client believes he will somehow “change” or be helped. I will definitely share this information with my therapist so that she can share it and hopefully help this woman save her own life!
The comment about medications changing the spontaneous nature of the sociopath and “All the “fun” part of the sociopath may disappear, leaving you with a boring parasite,” reflected another aspect of ex S. He has a history of seeking medical help for depression, anxiety, headaches, insomnia etc. only to either take them just long enough to feel better and thinks he no longer needs them OR, more often, stop taking them because HE doesn’t like how they make HIM feel… often saying they make him “tired” or “sedated”. (likely feelings he has because he hates perceieved boredom, etc). I am sure he is not isolated in such thinking and behavior as far as sociopaths are concerned.
Finally, Staying sane re: your comment “look at the quality of person on this site”have you noticed? very articulate, intelligent”.caring, balanced”.is this a result of having to survive a S or is it the quality that predisposes us to attracting them?” :
I personally think that the answer to your question is some combination of “all of the above”. 🙂
I also think sociopaths are drawn to the things in us that they lack in themselves whether they see it or not. Just as they are parasitic in other aspects of thier lives, I think they are emotional parasites in the sense that their partners have to “supply” or share with them all the good qualities they are lacking. When my S’s mask came off and I saw just how destructive he could be, I told my therapist that it was as if he had matched my goodness with an equal amount of evil!!! I guess that was a “compliment” to my goodness, LOL!
I have often said that initially my S “mirrored” so much of the good qualities in me, as if he was enamored by the effect and then his “mirroring” changed to where he perceived my good qualities as no longer “reflecting” on him in positive ways… and THEN his grandiosity kicked in as if to say ” how dare YOU reflect my weaknesses! oh wait! *I* have NO weaknesses! YOU are the problem! Must bring you down to size or throw you to the curb!” Classic devalue and discard when we are no longer a positive reflection, right?!
Additionally, there is a LF quiz to assess your risk of being the victim of a sociopath in the links that addresses your question of qualities predisposing us to attracting them. I *think* I scored a 34, but regardless ofthe score I am sure that I scored almost “perfect” as in perfect for attracting such characters! Lucky me, LOL!
Wow this got long – thanks for reading all of this if you stuck it out ’til the end!! And thanks again for the info, Dr. Leedom and to Staying sane for bringing it and your Q’s to the discussion! Have a great day!
Hecate’s Path
To change up General Custer’s quote: “The only GOOD PSYCHOPATH is a dead one.”
Stayingsane if you want to STAY SANE don’t ever let the thought of “curing” a psychopath lure you in.
Dr. Hare says after age 40 many times they ‘calm down” and quit being quite the horrible criminals they were (not robbing and killing as much) but every one I know that is dead was TOXIC right up to the last breath.
Even if let’s say they got 75% better, could you live with that 25% of lies and manipulation? I couldn’t. I don’t want to. Why not just stay away from them and hang with GOOD people who love and respect you.
Psychopaths are HARD WIRED, mostly by genetics, to be what they are. Do you think you can take an old rattle snake and it will become a puppy? Or quit being toxic. Just as “rational” to think a psychopath will “change for the better.”
Lots of people have wasted nearly all or all of their lives hoping against hope that their psychopath will “change” (and oh, sometimes they promise to, but they don’t follow through). I wasted nearly 30 years hoping my son would “reform” and what did I get for my trouble and pain? Attempted to murder me!
ps: stayingsane, that quality of the people here IS AMAZING isn’t it. I have been on several other blogs about suviving and many are filled with people who are cranky (sometimes the managers) or down right nasty, and just argue and don’t get it….not here. Sharp and caring people.
To answer your other question, yep, there are some threads on what makes us vulnerable and I suggest that you read “Women who love psychopaths” there are several things WE have in common just like there are things THEY have in common, and hyper caring is one of them that WE seem to have across the board.
I also suggest that you go back through all the archived articles and read EVERY ONE (will take a while!) because there are so omany good things here that are so informing and make sense both from an emotional standpoint and a scientific standpoint,
Stayingsane:
“what would it take”.for you to accept them back into your life?”
Me to be reincarnated into a fool!!!
My self esteem being so low that i fall for the ‘I love you more than anythings’,
The…..your the only woman i will ever love.
The…..please help me’s
The…..I miss ‘us’s
The…..fact that I would be willing to die
Shall I stop now?
You are in the ‘wishy/washy’, question yourself phase…..
Is it me?
Gosh, maybe it is me?
Maybe I am wrong and he really is a great person, I just couldn’t see it…….
Oh, how could I ever live with the thought of letting him go if I was wrong?
Am I making a big mistake here?
OKAY…….this is where the gut comes in….girl, you must listen to your gut and recall the red flags….
For me, I would rather be wrong and away from this person and happy than to be right and still with them.
There are obviously red flags…..reflect on those and ask yourself….is this really what I am worth? IS this really what I want to do forever….support them and get abused in return?
NO WAY JOSE!!!!!
Self respect, boundries, independance, patience, honor to yourself, self control and self love are all way more important then being in even a ‘semi-abusive’ relationship with ANYONE!
THEY DO NOT CHANGE, they have temporary ‘suck back in’ moments and once they are confident they have you ‘back’….the cycle continues.
I KNOW I DID IT FOR 28 years!!!!!
My ex S even at his deposition….several hours of obvious lies, documented deceit that my attorney called him out on…..ended this ‘meeting’ standing at the door, turned around and said with all the heartfelt he could muster……”I LOVE YOU ERIN”……
UH, yeah……OKAY! Luv you to babe, sincerely with all my heart!!!
THIS IS WHAT THEY DO……the suck in…..
It worked for years…..it was what we want to hear/believe etc….
Once the words come out, we suck into them….it’s our own fantasy.
You couldn’t pay me or give me the moon or anything else in this world and beyond to get back with the S. I will spend the rest of my life NC!
Also, it doesn’t matter if they are P’s, S’s, borderlines,Bi-polars, freaks, actors, snakes, monsters, thiefs, murderers or whatever you wish to call your particular problem relationship…..
THEY ARE TOXIC and HIGH CONFLICT, it’s not healthy and we all deserve BETTER!!!!!
We have to be in control of our own minds…..stay strong!
XXOO
I just have to warn people that Victor Frankl’s book “mans search for meaning” was used by my ex P to “get me in”. He learned it off by heart and always had it on him and quoted it ad nauseum when he was “courting me”. It worked. I had already told him that I had read that book and that loved it so he used it. I fell in love with a total psychopath disguised as Victor Frankl. I fell in love with Victor Frankl by proxy, all over again.
The extent these snakes in suits will go to is mind boggling.
I am also very impress with this article.
My ex P disguised as “victor frankle” was on very strong anti depressants by day, sleeping pills by night and an alcoholic into the bargain. The rest of the time he played golf, ripped off the health insurance ( for hundreds of thousands) ( he was an unemployed dentist) and spent the rest of the time manipulating people on the phone. He had to take viagra for sex ( he hid this fact for a year). All in all he was just what you would think Victor Frankl would be like (NOT!!!!).
I used to wonder what he would be like on anti psychotics ( a chemical straight jacket), but I have since seen sociopaths on them and I think they are just a bit slower.
When my ExP dentist dropped his anti depressent he became a million times more aggressive and deceitfula nd criminal.