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.
OXY:
TOWANDA! We beat the biopsy! AWESOME! xoxo(((OXY”S SON))).
I loved your analogy of the garden and the house and the cheese… you should write a fiction book Oxy, I wanted the story to go on forever!
Thankyou so much for being there Oxy, you have/are
helping me more than you will ever know.I wouldn’t be able to make it (as far as my P kids go) without you.oxxoxoxoxo
OxDrover, I just popped in to let you know that I, too, am so relieved that C’s biopsy turned out negative!
As you know, I just got “back” my second daughter, not physically yet, but emotionally, only to find out this morning that a mass has been found on her gallbladder. They think it is from the years of meds she’s taken for gluten intolerance but is a concern.
This morning she told me that an MRI will show more on Monday.
I am fighting the desire to cancel my own medical procedures scheduled for Tuesday and be ready to fly “home” if needed.
Tilly, I’ve been following your teeth problems, too. I hope you have felt my prayers. Abcesses are painful but I’ll bet you agree that the physical pain is easier to handle (but barely) than the emotional pain of living with/defending ourselves from an N/P/S, including your P teacher and friend!
ANEWLILY:
Yes thankyou, I have felt your prayers! And you are so right ANL…I HAVE HAD MY TWO TEETH PULLED OUT!!! And ever since I did NO MORE PAIN!!! (TOTALLY UNLIKE DEFENDING OURSELVES FROM A SOCIOPATH?PSYCHOPAT AYE LILY!!!LOL!)
And now i look like the angry raging monster i sometimes feel, so people will think twice about crossing me (ROTFLMAO)!
And I don’t have the thousands they want so I will be looking like this for quite awhile. God sure has a sense of humour…I wish I could bump into my exP dentist in a dark alley(shining a torch under my chin) now! (Rosa would like that one!)
And it is a relief to be out of the dating stakes completly. I intend on giving my P teacher a BIG SMILE tomorrow and see what comes pouring out of her mouth! lol!
P.S. If you cancel your appointment I will twang you with my boomerang. Prayers for your 2nd daughter. xo
Wish we could pull out the sociopath just as easy and toss him in the bin and be immediately free of pain !
LOL Tilly.
Reading the posts from yesterday. Thank you to all who have shared kind words with me. Tilly, you just used a word I can relate to: Did anyone feel like they had a Psycho-PET? I mean, really… Sometimes, looking back I recall the feeling like he was a pet. He was so parasitic, but good for wagging, when I was around. It’s incredible how the Pet was out destroying, but home in time to wag his “front” tail in what was described in another post “sexual aggressive master act”. Incredible how I’d let it go on. well, I did not: I stumped my feet, I called on every saint, and it got to the point when I prayed I could no longer pray for him as a part of my family, and wondered why. I tried harder and harder, and then to total dismay I started having a daily drink to “take the stress off”, which I had never done before or since. Psycho = pet – can we pull them out like a bad tooth?
http://www.reuters.com/article/newsOne/idUSTRE5764NI20090807?pageNumber=2&virtualBrandChannel=0
http://www.reuters.com/article/newsOne/idUSTRE5764NI20090807
Just so no one misses it, the above link is the second page, this is the first page. Thanks for the great article!!!
*sigh* first of all, I cannot claim to feel a sense of remorse towards the horror stories here, but here is how it is from the other side of the story.
Do we really come off as such complete bastards to those we hurt? I try and give the girl complete warning before she attempts to enter a relationship, and pay as much attention as I can to laws and social rules. When, and it’s always when, she wishes to leave a relationship I make no attempt to hold her back.
Is there any advice any of you could give me as to how to prevent such problems from arising? I am only 23, so I hope OxDrover’s comment about how after 40 we ‘calm down’ if true, but until then is there any hope? Should I even attempt to carry out a relationship?
Oh My,
This is a very old thread, I miss talking to ANewLily about potted plant’s and gardening.