What is sociopathy, does it relate to high functioning autism and can these conditions overlap, co-occur, or are professionals misdiagnosing autistic individuals as sociopaths, to their detriment? This was an interesting article to take on due to the controversy surrounding these diagnoses.
At first, when you start a research project based on sociopathy, or correctly termed as an antisocial personality disorder, you find opinion-based articles that make you wonder if most individuals understand the true nature and representation of the symptoms within an individual diagnosed with an antisocial personality disorder, such as psychopathy or sociopathy.
So, let’s discuss the idea of “sociopath vs autism”. In my own experience working with individuals diagnosed with autism and others with antisocial personality disorder (ASPD), it is evident that certain traits overlap. One such trait that is often the precursor for an opinion that some autistic persons are sociopaths is an “apparent” lack of empathy. I want to ensure that the message is not misconstrued here as there is a clear difference between an apparent lack of empathy and an actual lack of empathy.
Individuals diagnosed with autism spectrum disorder (ASD) or related conditions at times might display signs that they lack empathy. This might look like a teen deliberately breaking a glass for what seems like negative attention. Or perhaps your child waits until guests arrive until he rehearses swearwords and will laugh at you when they are being scolded? It might feel that, the more you become angry, the more apathy is displayed by your child. Perhaps you have a young adult who is still living at home and shows no motivation to follow the house rules or look for a way to become an independent adult. They might even explicitly state to you that they have no empathy for others.
Although the above might seem that your child is engaging in sociopathic behaviors or has an antisocial personality, what might not be as evident is the actual anxiety these individuals face daily which leads to these behaviors. Thus, the individuals that display an apparent lack of empathy most likely are displacing their lack of successful coping skills with challenging behaviors. This is different from that of sociopathy or sociopathic behaviors.
What is sociopathy then?
Sociopathy and psychopathy are often incorrectly used interchangeably in the media. Both these terms are part of the umbrella diagnosis of antisocial personality disorder (ASPD). Psychopaths and sociopaths have very similar traits, such as breaking laws, acting in ways that go against social norms, and feeling little to no guilt or empathy. This condition is only diagnosed at the age of 18 years. Children who are diagnosed with a conduct disorder, such as oppositional defiant disorder (ODD) could develop longer-lasting maladaptive antisocial behaviors that could qualify them for a diagnosis of ASPD. The overlapping characteristics of children diagnosed with ODD and ASD will be discussed later in this article.
There are some key traits that persons diagnosed with ASPD display, such as a lack of anxiety in stressful situations, no remorse when they were caught and questioned if they broke the law, hurt someone, or something, and a sense of entitlement throughout. The list of negative traits continues and is added to continuously, not only in the diagnostic manuals but also throughout media and via experiences of people in relationships with or as parents of individuals diagnosed with psychopathic and sociopathic traits.
The obvious question then is why are people not diagnosed earlier or easier and provided support to potentially reverse these traits? That might be a double-edged sword as the first answer is there is a whole different and pleasant and exciting side to sociopaths or psychopaths. The second part of the question is that even if individuals are diagnosed, they usually don’t see the need for therapy or have the motivation to change.
When you think of a “typical psychopath”, your mind probably starts scanning through some horrific Netflix series you have watched or famous serial killers. Seeing that roughly only 1-3% of the population is diagnosed with psychopathy or sociopathy, you might be surprised to know that many are undiagnosed and highly successful. They can be exceptionally charming and are usually extremely intelligent, witty, and engaging. These individuals can come across as caring, when they have the need, or even be the hero on a white horse to various charities.
The shrewdness of their acts, for their personal gain, is often overlooked by the naive and/or grateful recipient. The true nature of the psychopath or sociopath will only reveal itself when their wishes are not granted or their agenda is not met. The obstacles will be dealt with in a harsh, cold-hearted manner, quickly and effectively.
Before I add too much to the negative media portrayal, it is important to note that there is a key difference between psychopaths and sociopaths. Psychopaths are born psychopaths. Some research found these traits to be genetic and psychopathy and/or psychopathic traits can be traced back to other family members, especially the fathers. Sociopaths on the other hand are made. They have a history of trauma or child abuse and often a family history of this abuse dating back to previous generations. Another important note to make is that any person, no matter what they are diagnosed with, can make progress, gain insights and learn more successful coping skills. The key factor is to seek support and this is often not evident from a person diagnosed with an antisocial personality disorder.
What symptoms are similar between sociopaths and autistic individuals?
To answer this question, I will describe the similarities between oppositional defiant disorder (ODD) and autism spectrum disorder. If a child is diagnosed with ODD, the chances increase of a possible ASPD diagnosis later in life. This does not mean every child with a diagnosis of ODD will receive an ASPD diagnosis as an adult, but it does mean that an adult who receives an ASPD diagnosis most probably had an ODD diagnosis or displayed definite traits of a conduct disorder.
Oppositional defiant disorder is when a child engages in dangerous and maladaptive behaviors from a young age, such as hurting animals, peers, or siblings, setting fires, breaking items, and generally not showing any signs of remorse.
Some similarities between autistic children and those diagnosed with ODD are that they might be disruptive in social settings and they might act out if they don’t “get their way”. Both these groups of individuals might seem like they are not empathetic to feelings of disappointment or sadness from peers or family members. As mentioned before, if your child starts laughing when you are angry about a broken plate or glass, it might worry you as you feel they are not showing empathy.
There is an important difference though: individuals diagnosed with autism spectrum disorder are often exceptionally empathetic, they just struggle immensely with their anxiety in understanding, coping in, and regulating social constructs. Although many can understand a systematic construct, they might not understand why they are suddenly not allowed to walk away from the table, as the rules change when there are guests. Or if they are in public they have to speak in a different tone than at home.
These rules and changes in routine need to clearly be explained to them and practiced. If an autistic person, whether they are still young or in their adulthood, understands the reasoning behind a change, has time to prepare for this change and can practice it safely and predictably, they will feel less anxious and thus, exhibit more adaptive behaviors and responses.
In contrast, children diagnosed with ODD who possibly later get a diagnosis of ASPD as an adult, engage in these behaviors as they are hindered by any anxiety and determined to get their way. They are not able to feel anxiety the same as other people, as there is a difference in their automatic nervous system. These physiological differences make it difficult to understand the reason behind empathy, respect, and love for others. Again, this does not mean that a child diagnosed with ODD or an adult showing signs of sociopathic or psychopathic tendencies is incapable of successful relationships with their loved ones. With any condition, there are ways to optimize the person’s strengths and support them through difficult times.
Interventions available to treat sociopathic behaviors
Usually, individuals diagnosed with an antisocial personality disorder include “psychopaths” and “sociopaths” as previously explained. These persons have shown to do best with a combination of psychotherapy and medication. Psychotherapy or “talk therapy” could provide opportunities to implement strategies to work on anger management or possible addictions. Medication usually includes an antidepressant and a mood stabilizer. These interventions are carefully monitored for adults by their psychiatrist and should be discussed and reviewed regularly.
In recent years, studies have shown promising results with the introduction of Cognitive Behavioral Therapy (CBT) for children diagnosed with ODD. Cognitive Behavioral Therapy might include strategies such as restructuring, problem-solving, relaxation training, and verbal meditation. These strategies have shown positive results in children diagnosed with ODD in their mood and behavior. If done consistently and for long periods, it could lead to positive coping skills and decrease the chances of the child developing maladaptive and long-lasting antisocial behaviors.
Final thoughts
It’s important to seek professional medical advice when you suspect your child engages in sociopathic behaviors consistently. As discussed, your child might receive a conduct disorder diagnosis, if they qualify for the set of traits, which should be monitored into adulthood for signs of antisocial tendencies.
Any diagnosis, especially for our children, can be scary. If we search Google for answers, we might become more fearful. If there is anything that I would urge parents to take from this article it is that, no matter what condition your child might or might not have, there is support out there for you and your child. Make sure you speak to a doctor and get a second opinion. You are the true experts when it comes to your child and no matter what diagnosis is given, they are still your baby boy or girl.
References:
Battagliese, G. et al. Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness https://pubmed.ncbi.nlm.nih.gov/26575979/
Ghosh, A. et al. Oppositional defiant disorder: current insight https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5716335/
Rogers, J. et al. Autism spectrum disorder and psychopathy: shared cognitive underpinnings or double hit? https://pubmed.ncbi.nlm.nih.gov/17018169/
Schlesinger, LB. Distinctions between psychopathic, sociopathic and anti-social personality disorders https://pubmed.ncbi.nlm.nih.gov/7422762/
