Sociopaths, cluster B personality disorders and psychopathy

A sociopath is someone who has a pervasive and persistent disregard for the rights and feelings of others. This disregard is manifested in the antisocial behavior sociopaths show. While we usually think of antisocial behavior as criminal, not all antisocial acts are illegal. A person who slips up once is not a sociopath. Sociopathy is a lifestyle.

Since humans are designed to live in society, a healthy personality has prosocial inclinations. Therefore, people who are pervasively antisocial are disordered in the sense that they are not the norm (thank God). Although antisocial behaviors are observable actions like lying, stealing and assault, there are personality traits that cause antisocial behavior. It should come as no surprise that people who have a sense of entitlement, over-rate their own greatness and have poor self-control are more likely to hurt others and show pervasive antisocial behavior.

The American Psychiatric Association has defined a group of personality disorders it calls “cluster B”. According to a recent paper* by German psychiatrist, Christian Huchzermeier, M.D., “ The cluster includes disturbances of personality that go hand in hand with emotional dysregulation phenomena, a tendency towards aggressive—impulsive loss of control, egoistic exploitation of interpersonal relationships, and a tendency to overestimate one’s own importance.”

The disorders of “cluster B” go together because what underlies them is a disturbance in three developmentally acquired abilities I have called The Inner Triangle. These abilities are:

Ability to Love
Impulse Control
Moral Reasoning

These abilities that a child gains during development are a triangle because the development of each depends on the other two. A child begins to acquire ability to love in the first year of life, impulse control begins in the second year of life. At two years of age there is already a link between ability to love and impulse control. Children with the best impulse control also are the most loving/empathetic. Moral reasoning begins in the third year of life and its development depends on a loving nature and impulse control. Similarly the most moral kids are also the most loving and self-controlled.

I think of the cluster B disorders as different manifestations of damage to the inner triangle. I think of sociopaths as individuals who completely lack ability to love and have impaired impulse control and moral reasoning.

Given the Inner Triangle, it should come as no surprise that it can be difficult to find people who have only one cluster B personality disorder. For that reason individuals with antisocial personality, narcissistic personality, borderline personality and histrionic personality often have symptoms of the other disorders. If someone gets a diagnosis of only one of these, it doesn’t mean that the person doesn’t also have one or all of the others. The person making the diagnosis simply thought that the one chosen best described the person. You should know there is a gender bias in diagnosis such that women are often labeled “borderline.” These women can also be sociopaths who leave a trail of victimized friends, lovers and children in their wakes.

A recent study reported in Behavioral Science and the Law, “The Relationship Between DSM-IV Cluster B Personality Disorders and Psychopathy According to Hare’s Criteria: Clarification and Resolution of Previous Contradictions” examines the relationship between psychopathic personality traits as defined by the screening version of the PCL and Cluster B personality disorders. The authors of this study were careful to examine people who had only one cluster B disorder. They found psychopathy to be associated with all cluster B disorders.

The authors conclude:

“One clinical implication of our results, nevertheless, is that in cases where a cluster B personality disorder is diagnosed a high psychopathy value is to be expected, especially where antisocial, borderline or narcissistic personality disorder is involved. The PCL score is a better predictor of subsequent events, such as problems during (criminal) custody or a relapse into delinquency, than a diagnosis of a DSM-IV personality disorder, especially in forensic populations; therefore, an additional investigation with the PCL should be carried out, if a cluster B personality disorder has been diagnosed.”

It is important for Lovefraud readers to be aware of this study especially if there is a divorce/custody proceeding or a cluster B personality disorder has been diagnosed. Many people might think that if the partner has been “diagnosed borderline” or “diagnosed narcissistic” that means the partner is not a psychopath/sociopath. This study suggests otherwise. IF YOU ARE INVOLVED WITH SOMEONE WHO HAS THESE YOU HAVE TO CONSIDER THEIR HARMFUL BEHAVIOR AS AN INDICATION OF PSYCHOPATHY/SOCIOPATHY. There are some people with cluster B, histrionic, borderline and narcissistic disorders who are not highly antisocial. But if the person is lying, cheating and manipulating, that is antisocial behavior. This behavior in the context of any cluster B means the person is potentially very dangerous. As the authors state:

“Screening for PCL-based psychopathy can also be important for general psychiatric patients with a DSM-IV personality disorder, so that potential difficulties in the course of their treatment can be anticipated and this comorbidity can be targeted in the planning of therapy. Patients with both a DSM-IV personality disorder and PCL-based psychopathy can exhibit behavior that is particularly dangerous to therapy (Stafford & Cornell, 2003).”

If you have been diagnosed with borderline personality and reading this frightens you, I am sorry. You can improve by working on your inner triangle. Talk to your therapist about DBT a treatment that is very effective in improving the state of the Inner Triangle in people who are motivated to do it.

*The reference for the paper discussed is Behav. Sci. Law 25: 901—911 (2007).